{ "hospital_name": "Riverview Regional Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Riverview Regional Medical Center" ], "hospital_address": [ "600 South Third Street Gadsden, AL 35901" ], "license_information": { "license_number": "472228529", "state": "AL" }, "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": "John Langlois" }, "type_2_npi": [ "1992103857", "1669868923" ], "standard_charge_information": [ { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7042.0, "minimum": 3407.0, "maximum": 12154.48, "payers_information": [ { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10916.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6496.54 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10916.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10916.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11268.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10564.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7113.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6928.21 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6972.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10564.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6831.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12154.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7183.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9155.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7042.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6027.0, "minimum": 3407.0, "maximum": 19518.045, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9041.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5847.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10198.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6148.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7836.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9343.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3849.47 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9343.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9343.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9644.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9041.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6088.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3723.02 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6027.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5967.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "*11ADDL NECK SPINE FUSION", "code_information": [ { "code": "22552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6476.03, "minimum": 1942.809, "maximum": 6476.03, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6476.03 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6583.0, "minimum": 3407.0, "maximum": 16982.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9875.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6386.37, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11269.59 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6715.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8559.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10205.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10767.97 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10205.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10205.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10534.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9875.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6649.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8820.15 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6583.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6518.05, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6775.0, "minimum": 2380.0, "maximum": 13585.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10163.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6572.43, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11639.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6911.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8808.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10502.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6487.6 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10502.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10502.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10841.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10163.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6843.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5331.71 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6775.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6707.94, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13854.0, "minimum": 3407.0, "maximum": 25283.55, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20781.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13438.67, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13854.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25283.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14131.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18010.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21474.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22233.24 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21474.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21474.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22166.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20781.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13992.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13854.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16379.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13854.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13854.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13715.76, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6517.0, "minimum": 3407.0, "maximum": 11644.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9775.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.71, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11141.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6647.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8472.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10101.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10018.82 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10800.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10101.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10101.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10427.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9775.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6582.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8335.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6517.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6452.06, "additional_payer_notes": "99.00% 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": 8406.0, "minimum": 3407.0, "maximum": 38194.185, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12609.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8154.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14782.47 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8574.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10928.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13029.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22880.48 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13029.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13029.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13450.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12609.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8490.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11448.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8406.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8322.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35261.0, "minimum": 3407.0, "maximum": 75741.42, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35967.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45840.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 35261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 54655.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 75741.42 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 54655.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 54655.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 56419.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 52892.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 35614.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 73913.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35261.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 35261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34909.28, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 52892.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34204.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 35261.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 66547.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 35261.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11471.0, "minimum": 3407.0, "maximum": 24745.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17207.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11127.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11471.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20690.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11700.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14912.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17780.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14663.03 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17780.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17780.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18354.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17207.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11586.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11471.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6250.48 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11471.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11471.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11356.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5678.0, "minimum": 2512.85, "maximum": 13100.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8518.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5508.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9525.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5792.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7382.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8802.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3555.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8802.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8802.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9086.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8518.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5735.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2512.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5678.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5622.15, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8052.0, "minimum": 3407.0, "maximum": 19893.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12079.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7811.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14101.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8214.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10468.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12482.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4808.71 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12482.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12482.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12884.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12079.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8133.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3918.62 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8052.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7972.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17755.0, "minimum": 3407.0, "maximum": 35904.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26633.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17223.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 17755.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32803.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 17755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18111.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23082.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 27521.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 25730.49 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 27521.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 27521.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 28409.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26633.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 17933.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17755.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24268.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17755.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 17755.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17578.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ADJMTREVJ EXT FIXJ SYS ANES", "code_information": [ { "code": "20693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16148.2, "discounted_cash": 6476.0, "minimum": 243.24, "maximum": 16148.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3070.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 16148.22, "discounted_cash": 6476.0, "minimum": 243.24, "maximum": 16148.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3070.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5284.0, "minimum": 2853.807, "maximum": 15747.36, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7926.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5126.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8765.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5390.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6870.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8191.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7846.45 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8191.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8191.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8455.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7926.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5337.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7476.88 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5284.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5231.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10825.0, "minimum": 3407.0, "maximum": 19893.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16237.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10500.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10825.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19444.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11041.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14072.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16778.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13126.28 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16778.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16778.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17320.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16237.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10933.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10825.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12364.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10825.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10825.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10716.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9537.0, "minimum": 2205.5, "maximum": 27724.83, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14305.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9250.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16961.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9727.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12398.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14782.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15797.49 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14782.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14782.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15259.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14305.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9632.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13381.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9537.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9441.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5090.0, "minimum": 2646.6, "maximum": 8390.68, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7635.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4937.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8390.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5192.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6617.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7889.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7340.45 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7889.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7889.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8144.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7635.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5141.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6675.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5090.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5039.41, "additional_payer_notes": "99.00% 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": 7819.0, "minimum": 3407.0, "maximum": 17952.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11728.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7584.43, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13650.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10164.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12119.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14356.4 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12119.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12119.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12510.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11728.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7897.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12659.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7819.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7740.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13194.0, "minimum": 3407.0, "maximum": 24010.76, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19791.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12798.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13194.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24010.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13194.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13194.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13457.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17152.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13194.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20450.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20653.58 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20450.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20450.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21110.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19791.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13325.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13194.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22950.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13194.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13194.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13062.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8218.0, "minimum": 3407.0, "maximum": 21348.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12328.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7972.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14421.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8383.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10684.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12739.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15388.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12739.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12739.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13150.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12328.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8301.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20021.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8218.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8136.78, "additional_payer_notes": "99.00% 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": 5792.0, "minimum": 3407.0, "maximum": 13585.6, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5908.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7530.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8978.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9032.76 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8978.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8978.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9268.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8689.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5850.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8109.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5734.83, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8689.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5618.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9744.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5792.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4503.0, "minimum": 1323.3, "maximum": 17591.76, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6755.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4368.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7259.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4593.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5854.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 6980.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4849.83 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 6980.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 6980.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7205.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6755.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4548.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5058.18 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4503.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4458.53, "additional_payer_notes": "99.00% 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": 12465.0, "minimum": 3407.0, "maximum": 24745.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18697.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12091.15, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12465.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22605.85 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12465.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12465.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12714.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16204.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12465.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 19320.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 24572.79 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 19320.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 19320.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19944.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18697.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12589.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12465.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16724.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12465.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12465.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12340.45, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23491.0, "minimum": 3407.0, "maximum": 48720.78, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 35236.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22786.46, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 23491.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43858.92 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 23491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23961.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30538.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 23491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 36411.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 35069.87 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 36411.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 36411.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37585.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 35236.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23491.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32137.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 23491.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23256.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29429.0, "minimum": 3407.0, "maximum": 55304.27, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 44143.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28546.23, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 29429.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 55304.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 29429.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29429.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30017.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38257.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 29429.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 45615.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 44966.22 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 45615.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 45615.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 47086.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 44143.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 29723.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29429.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44026.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29429.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 29429.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29134.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14520.0, "minimum": 3407.0, "maximum": 26568.45, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21781.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14085.27, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14520.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26568.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14520.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14520.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14811.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18877.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14520.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 22507.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22413.83 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 22507.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 22507.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23233.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21781.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14666.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14520.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22066.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14520.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14520.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14375.69, "additional_payer_notes": "99.00% 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": 9639.0, "minimum": 3407.0, "maximum": 36875.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14459.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9350.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17159.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9832.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12531.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14941.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5645.47 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14941.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14941.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15423.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14459.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9736.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5973.72 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9639.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9543.2, "additional_payer_notes": "99.00% 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": 6288.0, "minimum": 2805.0, "maximum": 16011.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9433.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6100.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10701.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6414.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8175.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9747.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 14850.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 18000.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9747.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9747.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10062.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9433.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6351.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6288.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6226.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4684.0, "minimum": 3407.0, "maximum": 15984.5, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7027.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4544.14, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7608.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4778.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6090.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7261.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12087.48 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7261.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7261.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7495.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7027.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4731.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15984.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4684.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4637.83, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11312.0, "minimum": 3407.0, "maximum": 20383.93, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16968.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10973.03, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11312.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20383.93 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11538.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14706.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17534.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11343.69 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17534.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17534.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18099.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16968.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11425.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11312.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12497.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11312.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11312.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11199.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4927.0, "minimum": 3021.678, "maximum": 12468.78, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7391.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4779.61, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8076.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5025.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6405.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7637.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3836.06 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8100.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7637.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7637.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7883.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7391.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4976.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3585.04 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4927.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4878.16, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4616.0, "minimum": 1785.0, "maximum": 10189.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6925.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4478.27, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7477.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4709.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7155.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3895.06 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7155.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7155.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7386.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6925.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4662.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3131.33 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4616.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4570.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11711.0, "minimum": 3407.0, "maximum": 23289.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17567.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11360.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11711.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21153.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11711.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11711.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11946.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15225.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11711.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 18153.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10599.01 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 18153.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 18153.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18738.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17567.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11828.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11711.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9514.93 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11711.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11711.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11594.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Allgrft Implnt Knee W/Scope", "code_information": [ { "code": "29867", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40641.9, "discounted_cash": 11458.0, "minimum": 3900.0, "maximum": 40641.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16042.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22917.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 76314.0, "minimum": 3407.0, "maximum": 145677.98, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 76314.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 145677.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 76314.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 76314.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 77841.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 99209.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 76314.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 118288.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 141074.25 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 118288.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 118288.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 122103.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 114472.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 77078.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 76314.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95330.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 76314.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 76314.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75551.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 114472.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 74025.45, "additional_payer_notes": "97.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15048.0, "minimum": 3407.0, "maximum": 27656.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22572.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14597.14, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 15048.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27585.47 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 15048.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15048.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15349.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19563.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15048.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 23325.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14775.67 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 23325.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 23325.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24077.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 22572.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 15199.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16970.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15048.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 15048.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14898.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8159.0, "minimum": 3407.0, "maximum": 14306.09, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12238.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7914.44, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14306.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8322.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10606.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12646.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11678.93 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12646.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12646.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13054.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12238.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8240.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6983.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8159.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8077.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Finger/Thumb - 26952 - OR36026952", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Thru Metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30866.6, "discounted_cash": 2920.0, "minimum": 361.79, "maximum": 30866.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 361.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% 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": 9443.0, "minimum": 3407.0, "maximum": 25382.76, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14165.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9160.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16781.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9632.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12276.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14637.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13832.52 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14637.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14637.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15109.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14165.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13603.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9443.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9348.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29891 - OR36029891", "code_information": [ { "code": "29891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48892.0, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 48892.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22668.0, "minimum": 3407.0, "maximum": 48520.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23122.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29469.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 22668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 35136.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 47088.52 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 35136.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 35136.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36269.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 34002.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 22895.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22668.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19928.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22668.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 22668.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22442.01, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34002.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21988.64, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 22668.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 42273.39 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 22668.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27734.0, "minimum": 3407.0, "maximum": 52037.46, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41601.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26902.27, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 27734.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 52037.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 27734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28288.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36054.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 42988.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 42697.3 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 42988.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 42988.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 44374.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 41601.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 28011.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27734.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46819.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27734.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 27734.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27456.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ankle arthroscopysurgery", "code_information": [ { "code": "29897", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23801.92, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 23801.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 23801.9, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 23801.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6212.0, "minimum": 2853.807, "maximum": 12119.775, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9318.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6025.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10553.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6336.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8075.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9628.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10126.98 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9628.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9628.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9939.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9318.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6274.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5989.94 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6212.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6150.1, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Follow-Up Surgery", "code_information": [ { "code": "27884", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2920.0, "minimum": 1704.0, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3977.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Anterior Colporrhaphy", "code_information": [ { "code": "57240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23631.5, "discounted_cash": 4464.0, "minimum": 524.88, "maximum": 23631.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3747.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4554.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6250.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4241.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6920.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 6920.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8929.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4509.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 524.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4420.13, "additional_payer_notes": "99.00% 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": 27295.0, "minimum": 2205.5, "maximum": 51192.57, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40943.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26477.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 27295.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 51192.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 27295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27841.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35484.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 42308.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4048.83 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 42308.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 42308.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43673.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 40943.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 27568.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27295.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5567.08 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27295.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 27295.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27022.94, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29898 - OR36029898", "code_information": [ { "code": "29898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48892.0, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 48892.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% 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": 18663.0, "minimum": 3407.0, "maximum": 35419.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27995.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18103.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 18663.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 34553.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 18663.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18663.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19036.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24262.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18663.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 28928.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 32588.2 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 28928.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 28928.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29861.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 27995.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18663.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16914.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18663.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 18663.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18476.67, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Arthro/shoul surg; w/spacer", "code_information": [ { "code": "C9781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13547.3, "discounted_cash": 11458.0, "minimum": 3900.0, "maximum": 13547.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13547.3, "discounted_cash": 11458.0, "minimum": 3900.0, "maximum": 13547.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13547.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Wrist With Autograft", "code_information": [ { "code": "25825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74622.0, "discounted_cash": 6476.0, "minimum": 460.29, "maximum": 74622.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31688.0, "minimum": 3407.0, "maximum": 59659.62, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47532.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 30737.94, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 31688.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 59659.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 31688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32322.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41195.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 31688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 49117.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 38626.12 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 49117.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 49117.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 50701.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 47532.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 32005.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31688.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32120.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31688.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 31688.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31371.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRODESIS, ANT INTERBODY TECH,LUMBAR", "code_information": [ { "code": "22558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7289.96, "discounted_cash": 24217.0, "minimum": 2186.988, "maximum": 7289.96, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6587.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7289.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7289.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 6587.0 } ] } ] }, { "description": "Arthrd Dst Rad/Ul Jt Sgm Rsc", "code_information": [ { "code": "25830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68189.5, "discounted_cash": 6476.0, "minimum": 3900.0, "maximum": 68189.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7240.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Finger/Thumb - 26951 - OR36026951", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25580.9, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 25580.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRODESIS, EACH ADDITIONAL SPACE", "code_information": [ { "code": "22585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6035.33, "minimum": 1810.599, "maximum": 6035.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6035.33 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 } ] } ] }, { "description": "Av Fusion Direct Any Site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57543.9, "discounted_cash": 2818.0, "minimum": 374.23, "maximum": 57543.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4500.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29385.5, "discounted_cash": 2920.0, "minimum": 524.88, "maximum": 29385.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4429.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 524.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% 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": 12499.0, "minimum": 3407.0, "maximum": 27656.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18748.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12124.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22671.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12749.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16248.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 19373.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15898.51 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 19373.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 19373.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19998.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18748.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12624.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12337.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12499.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12374.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ARTHRT ELBW JT EXPL BX RMVL", "code_information": [ { "code": "24101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29417.2, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 29417.18, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 29417.18, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 29417.18, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Arthrp ntrcrpl/crp/mtcrp ssp", "code_information": [ { "code": "25448", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22149.74, "discounted_cash": 2920.0, "minimum": 524.88, "maximum": 22149.74, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 524.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% 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": 9656.0, "minimum": 3407.0, "maximum": 22954.83, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14484.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9366.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17192.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9849.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12553.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14967.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11526.07 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14967.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14967.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15450.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14484.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9753.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11217.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9656.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9560.01, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Aspirate/Inj Ganglion Cyst", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 273.0, "minimum": 181.458, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Of Toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2751.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4970.0, "minimum": 3021.678, "maximum": 12527.61, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7456.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4821.7, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8160.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5070.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6462.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7704.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5414.82 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7704.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7704.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7953.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7456.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5020.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4228.68 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4970.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4921.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17465.0, "minimum": 3407.0, "maximum": 32243.86, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26198.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16941.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 17465.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32243.86 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 17465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17814.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22704.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 27071.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26330.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 27071.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 27071.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27944.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 26198.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17465.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19287.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17465.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 17465.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17290.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34899.0, "minimum": 3407.0, "maximum": 79087.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 52349.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 33852.71, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 34899.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 65848.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 34899.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 34899.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35597.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45369.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 34899.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 54094.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 61295.62 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 54094.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 54094.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 55839.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 52349.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 35248.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34899.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54378.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34899.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 34899.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34550.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Amputation Toe & Metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 20014.0, "payers_information": [ { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16202.0, "minimum": 3407.0, "maximum": 29809.81, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24303.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15716.43, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16202.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29809.81 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16202.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16202.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16526.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21063.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16202.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 25113.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22494.28 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 25113.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 25113.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25924.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24303.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 16364.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16202.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16177.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16202.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16202.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16040.48, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Av Fistula Revision Open", "code_information": [ { "code": "36832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74445.9, "discounted_cash": 4966.0, "minimum": 460.29, "maximum": 74445.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4500.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5065.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6952.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4718.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9932.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5016.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4916.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8967.0, "minimum": 3407.0, "maximum": 19810.605, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13451.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8698.92, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15864.95 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9147.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11658.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13900.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10634.76 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13900.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13900.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14348.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13451.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10906.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8967.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8878.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "AUTOTRANSPLANT PARATHYROID", "code_information": [ { "code": "60512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14563.6, "minimum": 511.0, "maximum": 14563.59, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5390.18 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] }, { "setting": "outpatient", "gross_charge": 14563.59, "minimum": 511.0, "maximum": 14563.59, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5390.18 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Biopsy of rectum", "code_information": [ { "code": "45100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7014.22, "discounted_cash": 2477.0, "minimum": 243.24, "maximum": 7014.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1879.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2526.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2353.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4954.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2502.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2452.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15173.0, "minimum": 3407.0, "maximum": 27826.69, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22760.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14718.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 15173.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27826.69 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 15173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15477.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19725.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 23519.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16914.07 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 23519.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 23519.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24277.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 22760.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 15325.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15173.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21322.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15173.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 15173.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15021.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5151.0, "minimum": 3357.42, "maximum": 16577.34, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7726.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4996.77, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8508.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5254.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6696.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7984.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4571.81 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7984.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7984.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8242.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7726.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5202.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5358.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5151.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5099.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Bone Biopsy Trocar/Ndl Deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13316.0, "minimum": 3407.0, "maximum": 24245.92, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19974.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12916.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13316.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24245.92 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13316.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13316.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13582.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17310.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13316.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20639.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19844.53 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20639.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20639.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21305.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19974.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13316.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18087.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13316.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13316.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13182.84, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ankle Arthroscopy/Surgery - 29892 - OR36029892", "code_information": [ { "code": "29892", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36416.4, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 36416.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6844.0, "minimum": 3407.0, "maximum": 14556.45, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10267.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6639.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11772.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6981.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8898.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10609.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6747.75 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10609.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10609.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10951.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10267.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6913.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5937.18 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6844.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6776.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10132.0, "minimum": 3357.42, "maximum": 22818.09, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15198.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9828.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10132.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18108.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10334.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13171.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 15704.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16122.9 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 15704.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 15704.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16211.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15198.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10233.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10132.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14170.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10132.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10132.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10030.68, "additional_payer_notes": "99.00% 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": 43990.0, "minimum": 3407.0, "maximum": 83372.18, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 65986.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 42670.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 43990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 83372.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 43990.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43990.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44870.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 57187.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43990.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 68185.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14885.64 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 68185.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 68185.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 70385.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 65986.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 44430.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12246.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43990.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 43990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43550.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24240.0, "minimum": 3407.0, "maximum": 45302.62, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36360.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23512.99, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 24240.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 45302.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 24240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24725.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 31512.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 24240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 37572.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 32116.17 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 37572.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 37572.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 38784.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 36360.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 24482.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24240.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26746.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24240.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 24240.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23997.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.25%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "63323046557", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 75.75, "10th_percentile": 75.75, "90th_percentile": 77.25, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23160.0, "minimum": 3407.0, "maximum": 52745.61, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34740.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22465.59, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 23160.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43221.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 23160.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23160.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23623.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30108.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 23160.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 35898.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 52745.61 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 35898.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 35898.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37056.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 34740.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 23392.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23160.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47338.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23160.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 23160.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22928.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10255.0, "minimum": 3407.0, "maximum": 21227.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15383.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9948.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18347.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10461.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13332.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 15896.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20297.78 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 15896.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 15896.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16409.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15383.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10358.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21227.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10255.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10153.34, "additional_payer_notes": "99.00% 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": 16957.0, "minimum": 3407.0, "maximum": 31264.42, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25435.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 31264.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17296.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22044.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 26283.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19744.4 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 26283.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 26283.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27131.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25435.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 17126.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20673.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16787.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38500 - OR36038500", "code_information": [ { "code": "38500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23631.5, "discounted_cash": 3494.0, "minimum": 325.58, "maximum": 23631.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3687.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3564.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3319.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6989.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3529.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3459.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15798.0, "minimum": 3407.0, "maximum": 29030.38, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23697.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15324.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 15798.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29030.38 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 15798.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15798.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20537.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15798.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 24487.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20474.79 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 24487.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 24487.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25277.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23697.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 15956.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15798.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23606.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15798.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 15798.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15640.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3599.0, "minimum": 441.1, "maximum": 5758.784, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 5398.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 3491.26, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 5516.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 3671.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 4679.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 5578.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4363.5 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 5578.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 5578.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 5758.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 5398.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 3635.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3979.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 3599.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3563.25, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38525 - OR36038525", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 3494.0, "minimum": 325.58, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3687.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3564.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3319.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6989.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3529.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3459.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7935.0, "minimum": 3189.549, "maximum": 22537.19, "payers_information": [ { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12300.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22537.19 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 8550.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12300.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12300.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12697.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11903.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8015.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13653.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7856.61, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11903.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7697.89, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13875.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7935.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8094.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10316.76, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35470.0, "minimum": 3407.0, "maximum": 67660.75, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 53205.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34406.0, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 35470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 66948.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 35470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36179.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46111.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 35470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 54978.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 67660.75 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 54978.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 54978.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 56752.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 53205.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 35824.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55286.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35470.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 35470.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35115.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5363.0, "minimum": 3407.0, "maximum": 11159.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8045.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5202.95, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8917.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5471.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6973.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8314.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5312.91 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8314.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8314.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8582.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8045.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5417.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4309.03 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5363.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5310.23, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5957.0, "minimum": 3407.0, "maximum": 13585.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8936.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5778.8, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10062.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6076.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7744.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9234.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5894.89 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9234.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9234.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9532.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8936.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6017.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4514.37 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5957.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5897.95, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13676.3, "discounted_cash": 11458.0, "minimum": 374.23, "maximum": 13676.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3070.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13676.25, "discounted_cash": 11458.0, "minimum": 374.23, "maximum": 13676.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3070.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13676.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10721.0, "minimum": 3407.0, "maximum": 22165.29, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16082.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10400.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10721.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19245.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10721.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10721.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10936.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13938.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10721.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16618.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22165.29 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16618.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16618.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17155.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16082.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10829.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10721.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16824.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10721.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10721.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10614.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8308.0, "minimum": 3407.0, "maximum": 16496.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12463.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8059.63, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14594.59 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8475.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10801.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12878.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10430.94 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12878.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12878.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13294.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12463.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8391.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7784.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8225.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14199.0, "minimum": 3407.0, "maximum": 32505.05, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21299.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13773.61, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14199.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25949.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14199.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14199.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14483.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18459.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14199.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 22009.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 32505.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 22009.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 22009.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22719.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21299.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14341.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14199.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25954.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14199.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14199.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14057.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Si Jt Perq/Min Nvas", "code_information": [ { "code": "27279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33599.4, "discounted_cash": 15649.0, "minimum": 542.16, "maximum": 33599.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18611.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15962.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21908.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14866.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24256.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24256.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31298.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15805.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 542.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 6587.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 6587.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15649.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15492.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20497.0, "minimum": 3407.0, "maximum": 38087.75, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30745.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19882.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 20497.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38087.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 20497.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20497.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20907.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26646.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20497.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 31770.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26877.46 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 31770.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 31770.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32795.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30745.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 20702.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20497.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25275.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20497.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 20497.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20292.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12868.0, "minimum": 3407.0, "maximum": 24550.7, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19303.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12482.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12868.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23384.07 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12868.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12868.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13126.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16729.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12868.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 19946.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 24525.4 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 19946.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 19946.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20590.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19303.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12997.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12868.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24550.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12868.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12868.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12740.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Arthrd Wrist W/Sliding Graft", "code_information": [ { "code": "25805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52806.6, "discounted_cash": 6476.0, "minimum": 460.29, "maximum": 52806.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7240.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8889.0, "minimum": 3407.0, "maximum": 19893.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13334.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8622.67, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15713.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9067.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11556.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13778.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13411.46 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13778.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13778.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14222.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13334.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8978.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11766.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8889.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8800.46, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12955.0, "minimum": 882.2, "maximum": 23550.14, "payers_information": [ { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12955.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20080.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19700.6 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20080.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20080.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20728.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19432.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13084.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12955.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18267.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12955.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12955.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12825.45, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19432.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12566.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12955.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23550.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12955.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12955.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16841.5, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.5%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "55150017030", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 75.75, "10th_percentile": 75.75, "90th_percentile": 77.25, "count": "1 through 10" } ] } ] }, { "description": "Arthrodesis Subtalar", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41719.1, "discounted_cash": 11458.0, "minimum": 460.29, "maximum": 41719.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16042.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22917.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4950.0, "minimum": 3407.0, "maximum": 10189.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7426.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4802.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8121.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5049.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6435.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7673.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3875.39 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7673.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7673.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7921.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7426.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5000.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3837.46 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4950.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4901.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4058.12, "maximum": 24012.975, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13556.28 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15826.3 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8262.0, "minimum": 3407.0, "maximum": 14504.89, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12393.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8014.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14504.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8427.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10741.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12806.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11124.67 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12806.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12806.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13219.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12393.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8344.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10480.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8262.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8179.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Inj 0.5%", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "63323046757", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 75.75, "10th_percentile": 75.75, "90th_percentile": 77.25, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10647.0, "minimum": 3407.0, "maximum": 19101.45, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15970.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10327.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10647.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19101.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10647.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10647.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10860.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13841.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10647.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16502.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8922.8 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16502.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16502.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17035.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15970.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10753.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10647.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13490.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10647.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10647.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10540.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.25%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "55150016830", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 75.75, "10th_percentile": 75.75, "90th_percentile": 77.25, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38511.0, "minimum": 3407.0, "maximum": 72810.5, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57766.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37355.96, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 72810.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39281.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50064.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 59692.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 35803.83 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 59692.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 59692.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 61618.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 57766.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 38896.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30578.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 38511.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38126.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Autgrft Implnt Knee W/Scope", "code_information": [ { "code": "29866", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37824.9, "discounted_cash": 6476.0, "minimum": 440.8, "maximum": 37824.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 440.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Hcl Preservative Free (Pf) Inj 0.75%", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00409116519", "type": "NDC" }, { "code": "J0665", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 75.75, "10th_percentile": 75.75, "90th_percentile": 77.25, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29781.0, "minimum": 3407.0, "maximum": 55984.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 29781.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 55984.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 29781.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29781.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30377.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38716.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 29781.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 46161.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 42080.45 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 46161.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 46161.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 47650.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 44672.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 30079.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29781.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43484.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29781.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 29781.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29484.08, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 44672.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28888.44, "additional_payer_notes": "97.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38027.0, "minimum": 3407.0, "maximum": 79087.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57041.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 36886.87, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 38027.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 71878.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 38027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38788.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49436.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 58942.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 48090.67 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 58942.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 58942.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 60844.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 57041.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 38407.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38027.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40768.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38027.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 38027.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37647.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12626.0, "minimum": 3407.0, "maximum": 22916.17, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18939.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12247.32, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12626.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22916.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12626.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12626.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12878.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16413.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12626.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 19570.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19030.12 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 19570.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 19570.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20201.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18939.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12752.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22515.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12626.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12499.84, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10987.0, "minimum": 3357.42, "maximum": 24306.33, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16480.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10657.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10987.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19757.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11207.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14283.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17030.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20580.28 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17030.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17030.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17579.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16480.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11097.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10987.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13674.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10987.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10987.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10877.43, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6214.0, "minimum": 3407.0, "maximum": 15041.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9321.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6027.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10556.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6338.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8078.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9631.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5707.16 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13950.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9631.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9631.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9942.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9321.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6276.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4636.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6214.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6151.97, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32433.0, "minimum": 3407.0, "maximum": 61096.04, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 48650.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31460.79, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 32433.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 61096.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 32433.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32433.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33082.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42163.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 32433.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 50272.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 36280.32 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 50272.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 50272.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 51894.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 48650.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 32758.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32433.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35415.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32433.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 32433.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32109.46, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22869.0, "minimum": 3407.0, "maximum": 42661.29, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34304.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22183.8, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 22869.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 42661.29 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 22869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23327.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29730.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 22869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 35448.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 28753.92 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 35448.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 35448.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 36591.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 34304.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 23098.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22869.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26782.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22869.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 22869.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22641.2, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11110.0, "minimum": 4058.12, "maximum": 20378.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16665.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10777.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11110.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19994.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11332.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14443.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17221.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17221.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17221.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16665.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11221.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4543.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11110.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10999.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16957.0, "minimum": 3407.0, "maximum": 31264.42, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25435.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16448.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 31264.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17296.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22044.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 26283.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 21926.61 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 26283.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 26283.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27131.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25435.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 17126.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15808.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16957.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16787.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30950.0, "minimum": 3407.0, "maximum": 58236.52, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46425.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 30021.79, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 30950.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 58236.52 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 30950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31569.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40235.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 30950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 47973.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 41349.18 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 47973.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 47973.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49520.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 46425.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 31259.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30950.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41295.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30950.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 30950.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30640.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13788.0, "minimum": 3407.0, "maximum": 25156.27, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20682.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13374.65, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13788.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25156.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13788.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13788.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14064.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17924.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13788.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21371.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9954.45 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21371.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21371.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22061.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20682.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13926.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13788.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9964.58 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13788.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13788.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13650.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21193.0, "minimum": 3407.0, "maximum": 47954.5, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31789.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20557.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 21193.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 39429.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 21193.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21193.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21617.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27551.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21193.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 32849.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 28569.76 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 32849.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 32849.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33909.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 31789.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 21405.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21193.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47954.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21193.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 21193.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20981.37, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8964.0, "minimum": 3407.0, "maximum": 18922.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13446.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8695.26, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15857.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9143.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11653.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13894.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9691.62 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13894.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13894.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14342.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13446.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9053.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7334.84 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8964.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8874.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8096.0, "minimum": 3407.0, "maximum": 18922.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12144.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7853.45, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14184.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8258.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10525.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12549.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12313.66 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12549.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12549.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12954.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12144.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8177.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11375.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8096.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8015.38, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42087.0, "minimum": 3407.0, "maximum": 89209.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40825.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 42087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 79704.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42929.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54714.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 65235.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 89209.2 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 65235.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 65235.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 67340.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 63131.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 42508.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42628.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 42087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41666.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 63131.57, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5265.0, "minimum": 2853.807, "maximum": 8727.66, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7897.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5107.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8727.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5370.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6844.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8160.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5909.19 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 7650.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8160.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8160.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8424.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7897.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5317.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5319.52 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5265.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5212.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Iv Syringe In Ns", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "99999070325", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 20.58, "10th_percentile": 20.58, "90th_percentile": 20.58, "count": "1 through 10" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5277.0, "minimum": 3162.17, "maximum": 11789.055, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7916.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5119.38, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8751.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5383.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6861.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8180.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7252.85 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8180.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8180.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8444.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7916.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5330.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3162.17 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5277.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5224.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62258.0, "minimum": 3407.0, "maximum": 118584.66, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 93388.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 60391.13, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 62258.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 118584.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 62258.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 62258.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 63504.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 80936.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 62258.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 96501.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 89708.04 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 96501.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 96501.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 99614.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 93388.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 62881.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62258.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 93155.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 62258.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 62258.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61636.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 272303.0, "minimum": 3407.0, "maximum": 523451.11, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 408455.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 264134.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 272303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 523451.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 272304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 272304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 277750.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 353995.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 272304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 422070.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 266014.87 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 422070.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 422070.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 435685.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 408455.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 275027.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 272303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 294809.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 272304.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 272303.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 269580.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Iv Syringe In Sw", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "99999070125", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 20.58, "10th_percentile": 20.58, "90th_percentile": 20.58, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14429.0, "minimum": 3407.0, "maximum": 26392.69, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21644.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13996.91, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14429.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26392.69 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14429.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14429.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14718.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18758.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14429.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 22366.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 18429.36 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 22366.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 22366.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23087.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21644.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14574.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21989.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14429.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14429.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14285.5, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34273.0, "minimum": 3407.0, "maximum": 64642.87, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51410.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 33245.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 34273.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 64642.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 34273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 34273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 34959.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44556.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 34273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 53124.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 47353.14 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 53124.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 53124.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 54838.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 51410.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 34616.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34273.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42542.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34273.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 34273.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33931.16, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Iv Soln 1 Gm And Dextrose 3.74% 50 Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264315311", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 20.58, "10th_percentile": 20.58, "90th_percentile": 20.58, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22462.0, "minimum": 3407.0, "maximum": 42697.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33693.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 21788.53, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 22462.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 41875.8 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 22462.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 22462.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29201.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 22462.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 34816.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 28611.78 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 34816.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 34816.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 35939.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 33693.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 22687.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22462.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36256.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22462.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 22462.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22237.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25079.0, "minimum": 3407.0, "maximum": 46919.66, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37618.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24326.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 25079.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 46919.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 25079.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25079.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25580.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32602.83, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25079.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 38872.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 30074.32 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 38872.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 38872.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 40126.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 37618.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 25329.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25079.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35034.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25079.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 25079.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24828.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12427.0, "minimum": 3407.0, "maximum": 22533.12, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18641.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12054.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12427.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22533.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12427.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12427.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12675.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16155.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12427.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 19262.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13885.27 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 19262.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 19262.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19883.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18641.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12551.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12427.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13593.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12427.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12427.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12303.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Carpal Tunnel Surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19335.0, "discounted_cash": 1742.0, "minimum": 325.58, "maximum": 19335.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9867.76, "10th_percentile": 9867.76, "90th_percentile": 9867.76, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1754.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Not To Exceed $4619", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 4686.87, "10th_percentile": 4686.87, "90th_percentile": 4686.87, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1777.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1655.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3485.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1760.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1725.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6038.0, "minimum": 3407.0, "maximum": 13100.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9057.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5857.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10218.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6159.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7850.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9359.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6469.72 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9359.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9359.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9661.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9057.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6099.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6520.76 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6038.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5978.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31103.0, "minimum": 3407.0, "maximum": 58532.29, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46655.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 30170.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 31103.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 58532.29 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 31103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31725.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40434.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 31103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 48210.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 37303.03 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 48210.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 48210.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49766.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 46655.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 31414.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31103.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35754.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31103.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 31103.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30792.76, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSYREMOVAL LYMPH NODES", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22803.15, "discounted_cash": 3494.0, "minimum": 325.58, "maximum": 22803.15, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3459.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3687.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3564.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3319.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6989.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3529.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 22803.2, "discounted_cash": 3494.0, "minimum": 325.58, "maximum": 22803.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3687.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3564.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4892.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3319.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5416.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6989.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3529.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3494.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3459.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Iv Soln 2 Gm And Dextrose 3% (50 Ml)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00264310511", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 88.6, "10th_percentile": 88.6, "90th_percentile": 132.85, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16176.0, "minimum": 3800.0, "maximum": 29760.11, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24265.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15691.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16176.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29760.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16500.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21029.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 25073.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10564.14 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 25073.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 25073.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24265.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 16338.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16176.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11814.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4543.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16176.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16176.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16015.03, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Blepharoplasty Upper Eyelid", "code_information": [ { "code": "15822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41719.1, "discounted_cash": 1841.0, "minimum": 325.58, "maximum": 41719.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6760.0, "minimum": 4058.12, "maximum": 12130.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10140.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6557.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11610.21 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6895.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8788.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10478.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6767.41 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10478.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10478.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10140.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6828.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6184.74 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4543.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6760.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6692.99, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6078.0, "minimum": 3407.0, "maximum": 21540.525, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9118.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5896.53, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10296.21 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6200.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7902.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9422.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5558.76 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9422.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9422.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9726.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9118.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6139.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5915.27 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6078.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6018.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9675.0, "minimum": 3407.0, "maximum": 22319.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14513.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17228.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9868.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12578.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14996.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9329.56 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14996.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14996.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15480.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14513.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9772.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10301.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9675.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9578.69, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6766.0, "minimum": 4058.12, "maximum": 14070.8, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4543.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6699.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10150.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6563.88, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11622.33 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6902.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8796.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10488.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7536.24 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10488.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10488.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10150.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6834.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6766.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8063.7 } ] } ] }, { "description": "Cltx Dst Rdl Fx/Ephys Sep W/", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19668.6, "discounted_cash": 1435.0, "minimum": 374.23, "maximum": 19668.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 566.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4724.0, "minimum": 1323.3, "maximum": 8486.625, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7086.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4582.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7685.19 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4818.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6141.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7322.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7229.61 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7322.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7322.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7558.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7086.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4771.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6346.26 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4724.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4677.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13864.0, "minimum": 3407.0, "maximum": 25302.94, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20796.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13448.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13864.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25302.94 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14141.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18023.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21489.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10660.69 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21489.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21489.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22183.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20796.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14003.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12620.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13864.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13864.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13725.76, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Rdl&Uln Shft Fx W/Mnpj", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19824.1, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 19824.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 566.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21510.0, "minimum": 3407.0, "maximum": 40041.78, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32266.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20865.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 21510.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 40041.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 21510.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21510.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21941.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27964.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21510.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 33341.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 30169.98 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 33341.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 33341.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34417.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 32266.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 21726.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21510.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24652.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21510.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 21510.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21295.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10559.0, "minimum": 3357.42, "maximum": 18932.96, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15839.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10242.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10559.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18932.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10559.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10559.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10770.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13727.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10559.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16367.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 17397.71 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16367.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16367.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16895.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15839.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10665.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10559.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18711.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10559.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10559.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10454.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9817.0, "minimum": 3407.0, "maximum": 25717.455, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14726.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9523.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17502.59 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10013.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12762.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 15217.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9078.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 15217.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 15217.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15708.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14726.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9915.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8347.78 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9817.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9719.39, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cltx Sho Dslc W/Mnpj W/Anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1435.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7466.0, "minimum": 3407.0, "maximum": 21514.29, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11200.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7242.83, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12971.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7616.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9706.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11573.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11401.8 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 9450.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11573.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11573.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11946.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11200.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7541.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9837.96 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7466.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7392.16, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4297.0, "minimum": 3021.678, "maximum": 8733.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6445.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4168.38, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 6862.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4383.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5586.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 6660.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4207.95 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 6660.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 6660.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 6875.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6445.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4340.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3660.52 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4297.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4254.33, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17040.0, "minimum": 3407.0, "maximum": 31425.64, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25561.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16529.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 17040.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 31425.64 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 17040.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 17040.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 17381.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22153.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17040.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 26413.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16053.17 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 26413.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 26413.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 27265.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 25561.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 17211.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17040.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12656.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17040.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 17040.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16870.39, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4058.12, "maximum": 99645.5, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 99645.5 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 } ] } ] }, { "description": "Cltx Sho Dslc W/Mnpj Wo Anes", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 220.0, "minimum": 209.1425, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 566.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 209.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 341.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 341.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 220.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 217.95, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6480.0, "minimum": 3407.0, "maximum": 11069.58, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9720.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6285.73, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11069.58 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6609.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8424.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10044.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7970.71 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10044.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10044.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10368.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9720.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6544.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7193.61 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6480.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6415.33, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13077.0, "minimum": 3407.0, "maximum": 24260.0, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13077.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13077.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12946.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19615.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12684.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13077.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23785.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13077.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13077.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13338.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17000.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13077.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20269.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14729.19 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20269.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20269.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20923.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19615.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13207.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13077.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12150.3 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10329.0, "minimum": 3407.0, "maximum": 18489.31, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15494.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10019.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10329.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18489.31 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10329.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10329.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10536.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13428.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10329.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16010.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10182.41 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16010.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16010.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16527.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15494.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10432.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10329.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10154.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10329.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10329.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10226.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45578.0, "minimum": 3407.0, "maximum": 86432.93, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 68367.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44211.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 86432.93 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46490.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 59252.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 70646.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 46603.09 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 70646.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 70646.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 72925.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 68367.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 46034.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52854.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 45578.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45122.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23141.0, "minimum": 3407.0, "maximum": 43184.95, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34712.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22447.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 23141.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43184.95 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 23141.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 23141.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 23604.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30084.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 23141.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 35869.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 34981.37 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 35869.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 35869.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 37026.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 34712.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 23373.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23141.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31566.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23141.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 23141.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22910.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5772.0, "minimum": 3407.0, "maximum": 11644.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8658.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5598.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9704.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5887.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7503.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8946.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6616.34 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8946.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8946.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9235.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8658.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5829.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4812.25 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5772.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5714.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7551.0, "minimum": 3407.0, "maximum": 15526.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11326.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7324.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13133.92 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7702.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9816.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11704.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8024.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11704.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11704.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12081.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11326.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7626.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8148.92 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7551.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7475.59, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13453.0, "minimum": 3407.0, "maximum": 25859.76, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20180.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13050.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13453.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24511.39 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13453.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13453.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13722.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17489.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13453.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20853.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 18522.34 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20853.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20853.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21525.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20180.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13588.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13453.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15835.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13453.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13453.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13319.16, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13959.0, "minimum": 3407.0, "maximum": 25485.98, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20939.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13540.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13959.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25485.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13959.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13959.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14238.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18147.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13959.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21636.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20502.5 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21636.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21636.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22334.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20939.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14098.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13959.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19204.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13959.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13959.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13819.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38863.0, "minimum": 3407.0, "maximum": 73489.32, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58295.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37697.6, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 38863.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 73489.32 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 38863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39640.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50522.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 60238.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 68358.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 60238.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 60238.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62181.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 58295.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 39252.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38863.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55035.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38863.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 38863.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38474.87, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12250.0, "minimum": 3407.0, "maximum": 22192.5, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18376.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11883.18, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12250.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22192.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12250.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12250.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12495.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15925.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12250.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 18988.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13756.54 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 18988.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 18988.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19601.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18376.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12373.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11573.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12250.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12250.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12128.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42087.0, "minimum": 3407.0, "maximum": 79704.14, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 63131.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 40825.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 42087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 79704.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42929.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54714.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 65235.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 56528.93 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 65235.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 65235.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 67340.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 63131.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 42508.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53598.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42087.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 42087.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41666.82, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11179.0, "minimum": 3407.0, "maximum": 20128.17, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16769.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10844.31, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11179.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20128.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11403.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14533.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17328.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14980.39 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17328.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17328.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17887.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16769.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11291.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11179.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14978.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11179.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11067.9, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37643.0, "minimum": 3407.0, "maximum": 71137.7, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56465.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 36514.1, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 37643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 71137.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 37643.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37643.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38396.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 48936.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 37643.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 58347.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 55251.44 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 58347.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 58347.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 60229.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 56465.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 38019.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49083.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37643.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 37643.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37266.97, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 69121.0, "minimum": 3407.0, "maximum": 131813.12, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 103682.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 67048.15, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 69121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 131813.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 69121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 69121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 70504.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 89858.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 69121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 107138.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8204.04 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 107138.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 107138.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 110594.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 103682.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 69813.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 69121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 98145.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 69121.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 69121.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68430.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49024.0, "minimum": 3407.0, "maximum": 93074.43, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49024.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61741.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49024.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 49024.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48533.96, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 73536.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 47553.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 49024.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 93074.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 49024.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 49024.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 50004.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63731.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 49024.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 75987.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 68351.79 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 75987.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 75987.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 78438.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 73536.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 49514.44, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27951.0, "minimum": 3407.0, "maximum": 57363.01, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41926.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27112.66, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 27951.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 52455.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 27951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28510.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36336.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 43324.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 57363.01 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 43324.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 43324.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 44721.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 41926.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 28230.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27951.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42927.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27951.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 27951.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27671.69, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7646.0, "minimum": 3407.0, "maximum": 13316.95, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11469.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7416.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13316.95 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7798.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9939.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11851.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13033.31 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11851.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11851.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12233.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11469.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7722.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12346.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7646.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7569.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15770.0, "minimum": 3189.549, "maximum": 28977.04, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23655.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15297.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 15770.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28977.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 15770.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15770.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16085.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20501.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15770.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 24444.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 21321.38 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 24444.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 24444.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25232.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23655.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 15928.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15770.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22313.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15770.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 15770.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15612.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13114.0, "minimum": 3407.0, "maximum": 23858.03, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19672.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12721.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13114.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23858.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13377.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17049.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20327.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19369.83 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20327.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20327.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20983.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19672.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13245.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13114.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16078.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13114.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12983.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48816.0, "minimum": 3407.0, "maximum": 92673.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 73224.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 47351.62, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 48816.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 92673.2 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 48816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49792.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63460.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 48816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 75664.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 67324.62 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 75664.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 75664.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 78105.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 73224.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 49304.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48816.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63693.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48816.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 48816.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48327.94, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Iv Syringe In Sw", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "09999080501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 88.6, "10th_percentile": 88.6, "90th_percentile": 132.85, "count": "1 through 10" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5217.0, "minimum": 3407.0, "maximum": 10189.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7826.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5061.43, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8636.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5322.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6783.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8087.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5008.96 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8087.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8087.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8348.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7826.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5270.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5395.82 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5217.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5165.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20290.0, "minimum": 3407.0, "maximum": 37688.95, "payers_information": [ { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 20493.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23052.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 20290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20087.3, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30435.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 20290.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 37688.95 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 20290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20696.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26377.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20290.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 31449.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26015.66 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 31449.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 31449.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32464.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30435.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 } ] } ] }, { "description": "Corrj Halux Rigdus W/Implt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26546.6, "discounted_cash": 6476.0, "minimum": 325.58, "maximum": 26546.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00409258501", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 88.6, "10th_percentile": 88.6, "90th_percentile": 132.85, "count": "1 through 10" } ] } ] }, { "description": "Clear Outer Ear Canal", "code_information": [ { "code": "69205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1171.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Corrj Halux Rigdus W/O Implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22425.7, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 22425.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cefazolin Sodium For Iv Soln 1 Gm And Dextrose", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00264310311", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 88.6, "10th_percentile": 88.6, "90th_percentile": 132.85, "count": "1 through 10" } ] } ] }, { "description": "Cltx Prx Hmrl Fx Mnpj+-Tract", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 566.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CYSTO WURETER STRICTURE TX", "code_information": [ { "code": "52341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7079.76, "discounted_cash": 3146.0, "minimum": 243.24, "maximum": 7079.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36773.0, "minimum": 3407.0, "maximum": 69461.26, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 55160.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35670.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 36773.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 69461.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 36773.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36773.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37509.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 47805.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 36773.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 56999.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 55555.39 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 56999.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 56999.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 58837.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 55160.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 37141.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36773.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51373.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36773.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 36773.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36405.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52235 - OR36052235", "code_information": [ { "code": "52235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 3146.0, "minimum": 374.23, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19471.3, "discounted_cash": 3146.0, "minimum": 374.23, "maximum": 19471.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4058.12, "maximum": 54546.98, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 54546.98 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 } ] } ] }, { "description": "Cystoscopy And Treatment - 52320 - OR36052320", "code_information": [ { "code": "52320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 3146.0, "minimum": 460.29, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy W/Biopsy(S)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21877.0, "discounted_cash": 1865.0, "minimum": 325.58, "maximum": 21877.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2611.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1772.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3731.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1847.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4058.12, "maximum": 39704.26, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 39704.26 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 } ] } ] }, { "description": "Dbrdmt Musc&/Fsca 1St 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19729.1, "discounted_cash": 659.0, "minimum": 325.58, "maximum": 19729.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 479.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 923.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 626.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1022.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1022.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1319.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 653.03, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURETERO STRICTURE TX", "code_information": [ { "code": "52344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13342.7, "discounted_cash": 3146.0, "minimum": 243.24, "maximum": 13342.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13342.68, "discounted_cash": 3146.0, "minimum": 243.24, "maximum": 13342.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 Gm", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "63323034610", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 20.58, "10th_percentile": 20.58, "90th_percentile": 20.58, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5066.0, "minimum": 3407.0, "maximum": 13907.73, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5015.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7599.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4914.42, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8344.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5167.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6586.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7852.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4364.41 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7852.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7852.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8106.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7599.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5117.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4878.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5066.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Decompress Fingers/Hand", "code_information": [ { "code": "26035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25122.6, "discounted_cash": 2920.0, "minimum": 460.29, "maximum": 25122.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3618.045, "maximum": 11644.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7909.92 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7115.7 } ] } ] }, { "description": "Ceftriaxone Sodium For Iv Soln 2 Gm And Dextrose 2.22% 50 Ml", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264315511", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 20.58, "10th_percentile": 20.58, "90th_percentile": 20.58, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7990.0, "minimum": 3407.0, "maximum": 16496.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11986.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7750.97, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13981.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8150.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10387.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12385.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11220.32 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12385.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12385.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12785.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11986.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8070.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10200.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7990.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7910.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Deep Muscle Biopsy", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16543.9, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 16543.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Destroy cth facet jnt addl", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6982.57, "minimum": 243.24, "maximum": 6982.57, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1091.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16344.0, "minimum": 3407.0, "maximum": 30082.55, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24516.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15853.68, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16344.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30082.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16344.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16344.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16670.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21247.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16344.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 25333.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 25732.27 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 25333.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 25333.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26150.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24516.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 16507.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16344.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19673.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16344.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16344.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16180.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8884.0, "minimum": 3407.0, "maximum": 18437.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13327.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8618.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15704.94 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9062.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11550.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13771.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16105.02 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13771.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13771.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14215.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13327.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8973.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13114.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8884.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8796.1, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Destruct B9 Lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 179.0, "minimum": 170.1165, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 277.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 277.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 177.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19264.0, "minimum": 3407.0, "maximum": 35711.89, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28896.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18686.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 19264.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 35711.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 19264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 19264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 19649.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25043.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 29860.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26135.46 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 29860.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 29860.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 30823.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 28896.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 19457.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22380.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19264.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 19264.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19071.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5995.0, "minimum": 3407.0, "maximum": 15350.655, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8993.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5816.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10136.21 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6115.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7794.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9293.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7085.67 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9293.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9293.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9593.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8993.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6055.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6558.91 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5995.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5935.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5192.0, "minimum": 3357.42, "maximum": 15217.89, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7789.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5037.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8588.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5296.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6750.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8048.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7133.95 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8048.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8048.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8308.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7789.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5244.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4730.27 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5192.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5140.89, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Destruction Anal Lesion(S)", "code_information": [ { "code": "46910", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19084.7, "discounted_cash": 1841.0, "minimum": 243.24, "maximum": 19084.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1879.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16089.0, "minimum": 2646.6, "maximum": 29592.83, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24134.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.3, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16089.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29592.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16411.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20917.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 24939.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20692.03 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 24939.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 24939.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25743.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24134.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 16250.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16089.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19122.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16090.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16089.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15929.1, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Double Osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23099.9, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 23099.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6654.0, "minimum": 3400.0, "maximum": 19408.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9981.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6454.69, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11405.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6787.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8650.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10314.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3965.69 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10314.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10314.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10646.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9981.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6720.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3723.83 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6654.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6587.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 120 Mg/30Ml", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "63323016530", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 11.38, "10th_percentile": 11.38, "90th_percentile": 47.68, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7403.0, "minimum": 4058.12, "maximum": 15041.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11105.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7181.82, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12850.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7552.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9625.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11476.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7981.44 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11476.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11476.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11105.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7477.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7454.15 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4543.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7403.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7329.9, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Dstl Mtar Osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23774.4, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 23774.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7760.0, "minimum": 4058.12, "maximum": 16011.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11640.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7527.7, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13537.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7915.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10088.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12028.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8167.39 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12028.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12028.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11640.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7838.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11033.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4543.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7760.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7682.91, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8187.97, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 8187.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8187.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8187.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8187.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8187.97, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Destroy Lumb/Sac Facet Jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 1742.0, "minimum": 243.24, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1091.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1777.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1655.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3485.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1760.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1725.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13734.0, "minimum": 3407.0, "maximum": 29201.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20601.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13322.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13734.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25052.02 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13734.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13734.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14008.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17854.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13734.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21288.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 29201.8 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21288.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21288.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21974.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20601.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13871.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13734.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18223.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13734.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13734.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13596.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35090.0, "minimum": 3407.0, "maximum": 66217.48, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 52636.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34038.08, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 35090.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 66217.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 35090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35792.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45618.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 35090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 54390.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 54536.25 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 54390.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 54390.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 56145.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 52636.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 35441.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35090.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52241.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35090.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 35090.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34739.89, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 Mg/Ml", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "55150023805", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 17.3, "10th_percentile": 17.3, "90th_percentile": 17.3, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 11.38, "10th_percentile": 11.38, "90th_percentile": 47.68, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9310.0, "minimum": 3407.0, "maximum": 18440.6, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18440.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9217.59, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13966.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9031.38, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16525.58 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9496.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12103.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9310.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14431.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12702.54 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14431.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14431.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14897.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13966.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9403.81, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20553.0, "minimum": 3407.0, "maximum": 39649.83, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30829.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19936.51, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 20553.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38195.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 20553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 20964.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26719.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 31857.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 30154.79 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 31857.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 31857.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 32884.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 30829.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 20758.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20553.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32358.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20553.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 20553.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20347.57, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7703.0, "minimum": 3407.0, "maximum": 16496.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11554.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7472.19, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13427.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7857.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10014.28, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11940.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8533.02 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11940.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11940.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12325.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11554.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7780.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7329.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7703.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7626.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20926.0, "minimum": 3407.0, "maximum": 38915.67, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31390.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20298.9, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 20926.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38915.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 20926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21345.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27204.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 32436.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26240.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 32436.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 32436.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33482.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 31390.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 21135.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20926.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25785.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 20926.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20717.43, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4774.0, "minimum": 3407.0, "maximum": 10189.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7161.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4631.37, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7782.16 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4870.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6206.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7400.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4534.26 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7400.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7400.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7639.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7161.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4822.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4063.91 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4774.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4726.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Correct metacarpal flaw", "code_information": [ { "code": "26565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6671.34, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 6671.34, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Diag laparo separate proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27714.58, "discounted_cash": 5395.0, "minimum": 374.23, "maximum": 27714.58, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4750.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5503.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7554.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5125.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8363.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8363.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10791.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5449.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5341.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 27714.6, "discounted_cash": 5395.0, "minimum": 374.23, "maximum": 27714.58, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4750.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5503.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7554.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5125.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8363.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8363.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10791.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5449.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5395.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5341.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6373.0, "minimum": 3407.0, "maximum": 14556.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9559.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6182.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10863.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6500.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8285.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9878.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5483.66 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000.0, "10th_percentile": 18000.0, "90th_percentile": 22500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9878.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9878.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10197.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9559.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6436.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5140.16 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6373.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6309.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14653.0, "minimum": 3407.0, "maximum": 26823.01, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21979.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14213.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26823.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14946.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19048.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 22712.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16957.87 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 24300.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 22712.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 22712.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23444.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21979.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14799.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16544.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14653.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14506.47, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10826.0, "minimum": 3407.0, "maximum": 19446.92, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16239.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10501.51, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10826.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19446.92 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10826.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10826.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11042.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14074.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10826.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16780.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 18331.03 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16780.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16780.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17322.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16239.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10934.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10826.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12213.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10826.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10826.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10718.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DIAPHRAGMATIC PROCEDURES AND RELATED HERNIA REPAIR - 0073", "code_information": [ { "code": "43282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50529.5, "discounted_cash": 9487.0, "minimum": 3900.0, "maximum": 50529.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8864.73 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4643.0, "minimum": 3357.42, "maximum": 10618.02, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6965.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4504.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7530.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4736.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6036.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7197.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4047.04 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7197.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7197.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7430.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6965.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4690.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3722.21 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4643.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4597.37, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7379.0, "minimum": 3407.0, "maximum": 16011.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11069.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7158.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12802.99 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7527.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9593.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11438.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9296.48 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11438.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11438.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11807.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11069.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7453.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8191.94 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7379.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7305.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7219.0, "minimum": 3407.0, "maximum": 13585.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10829.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7003.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12495.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7364.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9385.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11190.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8578.62 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11190.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11190.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11551.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10829.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7291.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7605.12 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7219.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7147.48, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6549.0, "minimum": 3407.0, "maximum": 11204.13, "payers_information": [ { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10479.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9824.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6615.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7209.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6484.43, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9824.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6353.43, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11204.13 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6680.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8514.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6549.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10152.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6839.82 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10152.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10152.39, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Claviculectomy Partial", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27965.4, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 27965.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5691.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29330.0, "minimum": 3407.0, "maximum": 55113.96, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43995.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 28450.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 29330.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 55113.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 29330.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 29330.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 29916.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38129.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 29330.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 45462.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 40993.38 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 45462.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 45462.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 46928.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 43995.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 29623.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29330.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34676.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29330.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 29330.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29037.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8344.0, "minimum": 3407.0, "maximum": 17467.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12516.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8093.79, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14662.47 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8510.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10847.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12933.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8111.07 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12933.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12933.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13350.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12516.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8427.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9314.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8344.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8260.67, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25338.0, "minimum": 3407.0, "maximum": 47419.07, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38007.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24578.05, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 25338.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 47419.07 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 25338.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25338.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25844.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32939.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25338.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 39274.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 40762.73 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 39274.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 39274.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 40541.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 38007.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 25591.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25338.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31639.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25338.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 25338.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25084.82, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx Rpr F/C/C/M/N/Ax/G/H/F", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23631.5, "discounted_cash": 362.0, "minimum": 344.6695, "maximum": 23631.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 507.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 562.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 562.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 725.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 359.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10989.0, "minimum": 3407.0, "maximum": 23289.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16483.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10659.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10989.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19760.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10989.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10989.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11208.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14285.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10989.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17033.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15811.79 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17033.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17033.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17582.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16483.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11099.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10989.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13250.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10989.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10989.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10879.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dilat Xst Trc Ndurlgc Px", "code_information": [ { "code": "50436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28056.9, "discounted_cash": 3146.0, "minimum": 243.24, "maximum": 28056.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1925.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7040.0, "minimum": 3407.0, "maximum": 14070.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10560.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6829.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12149.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7181.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9152.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10912.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7400.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10912.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10912.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11264.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10560.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7110.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6703.39 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7040.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6970.05, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52224 - OR36052224", "code_information": [ { "code": "52224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23739.9, "discounted_cash": 3146.0, "minimum": 325.58, "maximum": 23739.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7619.0, "minimum": 3407.0, "maximum": 14556.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11429.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7391.06, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13266.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7772.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9905.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11810.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8556.27 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11810.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11810.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12191.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11429.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7695.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7130.31 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7619.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7543.45, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9238.0, "minimum": 3407.0, "maximum": 17467.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13857.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8961.23, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16386.18 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9423.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12009.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14319.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15219.98 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14319.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14319.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14781.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13857.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9330.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12709.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9238.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9146.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52240 - OR36052240", "code_information": [ { "code": "52240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41719.1, "discounted_cash": 4785.0, "minimum": 374.23, "maximum": 41719.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4881.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6699.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4546.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7417.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7417.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9571.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4833.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4737.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Diphenhydramine Hcl Inj 50 Mg/Ml", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641037621", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9.6, "10th_percentile": 9.6, "90th_percentile": 9.6, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 23.16, "10th_percentile": 23.16, "90th_percentile": 23.16, "count": "1 through 10" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5914.0, "minimum": 3357.42, "maximum": 12234.99, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8871.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5736.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9978.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6032.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7688.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9166.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12234.99 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9166.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9166.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9462.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8871.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5973.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10114.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5914.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5855.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero & Or Pyeloscope", "code_information": [ { "code": "52351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 3146.0, "minimum": 374.23, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Jt Arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41719.1, "discounted_cash": 11458.0, "minimum": 374.23, "maximum": 41719.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16042.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22917.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero W/Stone Remove", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19760.7, "discounted_cash": 3146.0, "minimum": 460.29, "maximum": 19760.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cor Hlx Vlgs Rsc Prx Phlx Bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45336.7, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 45336.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystourethroscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 622.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 871.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 591.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 964.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 964.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1244.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 628.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 622.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 616.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53750.0, "minimum": 3407.0, "maximum": 102185.14, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 80626.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 52138.28, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 53750.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 102185.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 53750.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 53750.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54825.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69876.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 53750.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 83313.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 80528.67 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 83313.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 83313.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 86001.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 80626.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 54288.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53750.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 48084.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53750.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 53750.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53213.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13623.0, "minimum": 3407.0, "maximum": 24838.68, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20435.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13214.8, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13623.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24838.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13623.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13623.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13895.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17710.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13623.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21116.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 20096.63 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21116.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21116.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 21797.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 20435.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13759.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13623.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12372.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13623.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13623.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13487.27, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drain/Inj Joint/Bursa W/O Us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19609.3, "discounted_cash": 273.0, "minimum": 243.24, "maximum": 19609.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11245.0, "minimum": 3407.0, "maximum": 21834.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11245.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20254.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11470.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14618.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17429.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12135.76 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17429.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17429.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17992.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16867.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11357.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11245.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10868.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11245.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11245.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11132.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16867.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10907.75, "additional_payer_notes": "97.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27079.0, "minimum": 3407.0, "maximum": 50775.59, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40619.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26267.21, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 27079.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 50775.59 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 27079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 27079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27621.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35203.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 41973.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 42380.83 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 41973.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 41973.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43327.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 40619.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 27350.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27079.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39670.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27079.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 27079.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26808.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7890.0, "minimum": 3189.549, "maximum": 13809.945, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 11836.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7653.97, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13788.49 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8048.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10257.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12230.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13395.37 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12230.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12230.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 12625.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 11836.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7969.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3530.66 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7890.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7811.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bone Marrow Biopsies", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 286.51, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1515.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drain Lower Leg Lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20713.3, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 20713.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CPTRASST DIR MS PX", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29693.2, "minimum": 511.0, "maximum": 29693.2, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] }, { "setting": "outpatient", "gross_charge": 29693.2, "minimum": 511.0, "maximum": 29693.2, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8733.0, "minimum": 3407.0, "maximum": 16982.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13100.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8471.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15412.81 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8908.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11353.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13536.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12262.7 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13536.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13536.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13973.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13100.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8820.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9872.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8733.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8646.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drain Thigh/Knee Lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20728.4, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 20728.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16603.0, "minimum": 2646.6, "maximum": 30581.96, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24904.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16105.01, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30581.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16603.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16603.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16935.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21584.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16603.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 25734.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 24231.28 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 25734.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 25734.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 26565.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24904.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 16769.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23014.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16603.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16603.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16437.07, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Bone 1St 20 Sq Cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21615.5, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 21615.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1279.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Egd Us Transmural Injxn/Mark", "code_information": [ { "code": "43253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1712.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1220.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1746.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2397.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1627.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2654.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2654.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3425.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1729.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1695.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14053.0, "minimum": 3407.0, "maximum": 28626.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21079.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13631.41, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14053.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25666.59 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14053.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14053.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14334.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18268.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14053.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21782.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13386.43 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21782.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21782.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22484.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21079.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14193.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14053.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11569.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14053.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14053.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13912.47, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43067.0, "minimum": 3407.0, "maximum": 112447.28, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 64601.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41775.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 81592.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43928.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55987.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 66754.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 112447.28 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 66754.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 66754.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 68908.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 64601.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 43498.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 81244.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 43067.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42636.83, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt Subq Tis 1St 20Sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20868.5, "discounted_cash": 362.0, "minimum": 243.24, "maximum": 20868.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 479.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Not To Exceed $4619", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 2169.03, "10th_percentile": 2169.03, "90th_percentile": 2169.03, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 507.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 344.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 562.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 562.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 725.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 362.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "standard_charge_algorithm": "Not To Exceed $3900", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1007.91, "10th_percentile": 1007.91, "90th_percentile": 1007.91, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 359.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Elbow arthroscopysurgery", "code_information": [ { "code": "29836", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69894.24, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 69894.24, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 69894.2, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 69894.24, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7132.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 134217.0, "minimum": 3407.0, "maximum": 257286.57, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 201326.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 130190.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 134217.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 257286.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 134217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 134217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 136901.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 174482.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 134217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 208037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 215933.31 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 208037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 208037.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 214747.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 201326.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 135559.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 134217.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 209846.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 134217.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 134217.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 132874.83, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Create Eardrum Opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1384.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1171.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1412.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1938.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2146.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2146.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2769.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1398.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1370.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12875.39, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 12875.39, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1279.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12875.4, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 12875.39, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1279.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Endometr Ablate Thermal", "code_information": [ { "code": "58353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 4464.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2898.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4554.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6250.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4241.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6920.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 6920.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8929.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4509.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4464.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4420.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Elbow Arthroscopy/Surgery - 29837 - OR36029837", "code_information": [ { "code": "29837", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44067.6, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 44067.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cysto W/Irrg&Evac Mlt Clots", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 3146.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Debride Skin At Fx Site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19634.1, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 19634.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 479.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ENDOSCOPY MAXILLARY SINUS", "code_information": [ { "code": "31267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3381.82, "discounted_cash": 6298.0, "minimum": 374.23, "maximum": 3381.82, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 969.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3381.82, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cysto/Uretero W/Lithotripsy", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22217.6, "discounted_cash": 4785.0, "minimum": 460.29, "maximum": 22217.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5273.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4881.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6699.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4546.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7417.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7417.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9571.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4833.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4737.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Decompression Of Tibia Nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23631.5, "discounted_cash": 1742.0, "minimum": 374.23, "maximum": 23631.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3977.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1777.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1655.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3485.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1760.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1725.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7183.0, "minimum": 3407.0, "maximum": 16496.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10774.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6967.71, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12424.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7326.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9338.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11133.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7445.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11133.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11133.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11493.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10774.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7255.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6662.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7183.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7111.38, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52260 - OR36052260", "code_information": [ { "code": "52260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1865.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2611.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1772.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3731.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1847.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5568.0, "minimum": 3407.0, "maximum": 37376.13, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8353.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5401.81, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9313.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5680.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7239.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8631.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4646.0 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8631.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8631.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8910.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8353.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5624.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4179.98 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5568.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5513.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52281 - OR36052281", "code_information": [ { "code": "52281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19362.7, "discounted_cash": 1865.0, "minimum": 325.58, "maximum": 19362.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2611.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1772.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3731.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1847.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9110.0, "minimum": 3407.0, "maximum": 17467.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13666.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8837.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16140.11 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9292.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11843.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14121.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13044.04 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14121.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14121.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14577.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13666.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9201.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12452.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9110.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9019.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39277.0, "minimum": 3407.0, "maximum": 74286.93, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58915.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 38098.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 39277.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 74286.93 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 39277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40062.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 51060.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 39277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 60879.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 46271.42 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 60879.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 60879.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 62843.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 58915.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 39670.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39277.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34093.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39277.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 39277.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38884.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy Chemodenervation", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1865.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1903.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2611.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1772.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2891.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3731.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1884.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1865.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1847.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5353.0, "minimum": 3407.0, "maximum": 12429.825, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8029.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5192.58, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8897.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5460.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6959.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8297.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11385.71 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8297.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8297.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8565.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8029.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5406.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4041.99 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5353.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5299.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "CYSTOURESTHROS. WMANIP.WOUT REML.STONE", "code_information": [ { "code": "52330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13342.7, "discounted_cash": 3146.0, "minimum": 374.23, "maximum": 13342.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13342.68, "discounted_cash": 3146.0, "minimum": 374.23, "maximum": 13342.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1990.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3209.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4404.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2988.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4876.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6292.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3177.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3146.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3114.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Duct Stent Placement", "code_information": [ { "code": "43274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21442.8, "discounted_cash": 5418.0, "minimum": 325.58, "maximum": 24010.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5526.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7585.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5147.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8398.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8398.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10836.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5472.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5364.21, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.33 } ] } ] }, { "description": "Cystouretero W/Lithotripsy", "code_information": [ { "code": "52353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 4785.0, "minimum": 460.29, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3752.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4881.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6699.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4546.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7417.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7417.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9571.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4833.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4785.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4737.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14187.0, "minimum": 3407.0, "maximum": 27171.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21280.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13761.39, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25924.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14470.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18443.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 21989.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 22976.13 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 21989.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 21989.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 22699.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21280.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14328.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17635.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14187.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14045.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Ea Duct/Ampulla Dilate", "code_information": [ { "code": "43277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23739.9, "discounted_cash": 3441.0, "minimum": 325.58, "maximum": 23739.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3509.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4817.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3269.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6882.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3475.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3406.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ercp W/Specimen Collection", "code_information": [ { "code": "43260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21139.5, "discounted_cash": 3441.0, "minimum": 325.58, "maximum": 21139.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3255.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3509.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4817.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3269.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6882.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3475.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3406.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4058.12, "maximum": 16496.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10852.9 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11063.5 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8713.0, "minimum": 3407.0, "maximum": 18437.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13069.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8451.86, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15374.02 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8887.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11327.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13505.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10104.64 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 17100.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13505.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13505.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13941.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13069.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8800.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8406.22 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8713.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8626.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4645.0, "minimum": 3407.0, "maximum": 11159.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6967.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4505.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7532.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4737.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6038.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7199.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4841.78 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7199.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7199.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7432.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6967.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4691.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4649.11 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4645.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4598.62, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC ABDL TUM DEEP 5 CM>", "code_information": [ { "code": "22901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22743.11, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 22743.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 22743.1, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 22743.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15346.0, "minimum": 3407.0, "maximum": 29112.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23019.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14886.3, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 15346.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28160.04 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 15346.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 15346.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 15653.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19950.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15346.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 23787.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 23239.86 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 23787.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 23787.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 24554.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 23019.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 15500.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15346.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19638.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15346.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 15346.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15193.23, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13102.0, "minimum": 3407.0, "maximum": 28141.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19654.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13102.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23835.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13102.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13102.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13364.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17033.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13102.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20309.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15354.97 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20309.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20309.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20964.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19654.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13233.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13102.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9949.97 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13102.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13102.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12971.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC CHEST WALL TUMOR WRIBS", "code_information": [ { "code": "21601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19735.5, "discounted_cash": 2592.0, "minimum": 524.88, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 524.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19735.51, "discounted_cash": 2592.0, "minimum": 524.88, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 524.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6458.0, "minimum": 3407.0, "maximum": 20065.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9688.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6264.98, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11028.37 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6587.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8396.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10011.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6395.52 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10011.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10011.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10333.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9688.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6523.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6661.17 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6458.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6394.15, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5939.0, "minimum": 3407.0, "maximum": 10674.4, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10028.32 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6058.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7721.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9206.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6877.38 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9206.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9206.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9503.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8909.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5999.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5436.41 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5880.52, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8909.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5761.72, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5939.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Forearm Les Sc < 3 Cm", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22537.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 22537.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5639.0, "minimum": 3407.0, "maximum": 12130.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8459.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5470.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9450.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5752.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7331.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8741.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5931.55 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000.0, "10th_percentile": 18000.0, "90th_percentile": 18000.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8741.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8741.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9023.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8459.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5696.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5234.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5639.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5583.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11533.0, "minimum": 3407.0, "maximum": 35630.31, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17300.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11187.79, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11533.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20810.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11764.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14993.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17877.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 17862.58 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17877.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17877.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18454.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17300.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11649.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11533.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13118.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11533.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11533.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11418.46, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand les sc < 1.5 cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19254.16, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19254.16, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19254.16, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Destroy cervthor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13965.15, "discounted_cash": 1742.0, "minimum": 325.58, "maximum": 13965.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1091.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1777.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1655.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3485.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1760.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1725.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13965.2, "discounted_cash": 1742.0, "minimum": 325.58, "maximum": 13965.15, "payers_information": [ { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1655.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3485.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1760.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1725.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1091.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1777.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Drain Hand Tendon Sheath", "code_information": [ { "code": "26020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23673.0, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 23673.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hand Les Sc 1.5 Cm/>", "code_information": [ { "code": "26111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drain Shoulder Lesion", "code_information": [ { "code": "23030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21822.8, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 21822.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Leg/Ankle Tum Deep <5 Cm", "code_information": [ { "code": "27619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34484.1, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 34484.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Excessive Skin Abdomen", "code_information": [ { "code": "15830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87541.1, "discounted_cash": 5926.0, "minimum": 374.23, "maximum": 87541.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6045.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8297.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5630.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9186.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 9186.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11852.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5985.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5926.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5867.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Forearm Lesion", "code_information": [ { "code": "25028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2920.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Les Sc < 3 Cm", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc foottoe tum dep 1.5cm>", "code_information": [ { "code": "28041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21239.3, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 21239.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2751.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 21239.31, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 21239.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2751.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Pelvis Lesion", "code_information": [ { "code": "26990", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25122.6, "discounted_cash": 2920.0, "minimum": 243.24, "maximum": 25122.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4366.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC NECK LES SC 3 CM>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6578.5, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 6578.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 6578.5, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 6578.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC FOREARM TUM DEEP < 3 CM", "code_information": [ { "code": "25076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21176.2, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 21176.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 21176.21, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 21176.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9772.0, "minimum": 3407.0, "maximum": 19408.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9967.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12703.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 15147.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10451.5 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 15147.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 15147.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15635.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14658.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9870.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8679.74 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9674.57, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14658.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9479.12, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9772.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17415.32 } ] } ] }, { "description": "Dstrj Nulyt Agt Gnclr Nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 1742.0, "minimum": 243.24, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1479.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1777.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2439.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1655.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2701.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3485.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1760.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1742.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1725.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Neck Tum Deep < 5 Cm", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31969.2, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 31969.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hand Tum Deep < 1.5 Cm", "code_information": [ { "code": "26116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Dx Bone Marrow Bx & Aspir", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20014.0, "discounted_cash": 2592.0, "minimum": 286.51, "maximum": 20014.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1515.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Rect Tum Transanal Full", "code_information": [ { "code": "45172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30078.2, "discounted_cash": 2477.0, "minimum": 325.58, "maximum": 30078.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2526.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2353.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4954.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2502.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2452.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Hip Pelvis Les Sc 3 Cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45662.3, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 45662.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6807.0, "minimum": 3407.0, "maximum": 15526.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10211.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6603.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11701.13 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6943.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8850.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10552.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8034.19 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10552.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10552.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10892.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10211.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6875.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7569.41 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6807.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6739.69, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Egd Biopsy Single/Multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 809.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1220.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 825.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1133.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 769.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1618.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 817.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "standard_charge_algorithm": "Not To Exceed $3900", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1413.11, "10th_percentile": 470.26, "90th_percentile": 1768.19, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 801.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc rect tum transanal part", "code_information": [ { "code": "45171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20514.37, "discounted_cash": 2477.0, "minimum": 325.58, "maximum": 20514.37, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2526.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2353.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4954.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2502.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2452.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 20514.4, "discounted_cash": 2477.0, "minimum": 325.58, "maximum": 20514.37, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2865.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2526.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2353.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4954.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2502.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2452.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg >4 Cm", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22188.4, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 22188.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12023.0, "minimum": 3407.0, "maximum": 23289.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18035.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.99, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12023.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21754.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12023.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12023.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12264.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15630.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12023.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 18636.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16397.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 18636.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 18636.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19237.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18035.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12143.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12023.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14678.6 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12023.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12023.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11903.46, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Egd Diagnostic Brush Wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 809.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1220.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 825.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1133.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 769.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1618.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 817.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "standard_charge_algorithm": "Not To Exceed $3900", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 2291.31, "10th_percentile": 2291.31, "90th_percentile": 2291.31, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 801.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 0.5 cm<", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19735.5, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19735.51, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Skn Hdrdnt Ax Complex", "code_information": [ { "code": "11451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22188.4, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 22188.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5137.0, "minimum": 3407.0, "maximum": 11644.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7706.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4983.36, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 8481.59 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5240.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6678.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7963.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5904.73 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7963.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7963.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8219.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7706.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5188.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4874.75 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5137.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5086.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Egd Remove Foreign Body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20066.9, "discounted_cash": 809.0, "minimum": 325.58, "maximum": 20066.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1220.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 825.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1133.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 769.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1618.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 817.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 801.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg 0.6-1 cm", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7065.93, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 7065.93, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Tum Dep 5Cm/>", "code_information": [ { "code": "27339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25122.6, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 25122.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6027.0, "minimum": 3407.0, "maximum": 14556.0, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5967.06, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9041.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5846.51, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10196.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6147.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7835.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9342.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7090.14 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9342.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9342.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9643.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9041.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6087.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6185.56 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6027.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Elbow Arthroscopy/Surgery - 29838 - OR36029838", "code_information": [ { "code": "29838", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44603.7, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 44603.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2851.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXCCRTG B1 CSTB9 TUM RDS", "code_information": [ { "code": "24120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14792.3, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 14792.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 14792.27, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 14792.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg 3.1-4 cm", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9289.24, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 9289.24, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Endo Cholangiopancreatograph - 43261 - OR36043261", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 3441.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3255.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3509.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4817.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3269.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6882.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3475.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3406.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excise Parotid Gland/Lesion", "code_information": [ { "code": "42420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52571.7, "discounted_cash": 5283.0, "minimum": 524.88, "maximum": 52571.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5828.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5389.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7396.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5019.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10567.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5336.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 524.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5230.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excise Foot Tendon Sheath", "code_information": [ { "code": "28088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23631.5, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 23631.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2751.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Endo Cholangiopancreatograph - 43262 - OR36043262", "code_information": [ { "code": "43262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19895.0, "discounted_cash": 3441.0, "minimum": 325.58, "maximum": 19895.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3255.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3509.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4817.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3269.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 5333.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6882.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3475.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3406.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excision Olecranon Bursa", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21121.4, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 21121.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXCISE WRIST TENDON SHEATH", "code_information": [ { "code": "25118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12141.0, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 12141.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12141.0, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 12141.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Drainage Of Bone Lesion", "code_information": [ { "code": "26992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27965.4, "discounted_cash": 2920.0, "minimum": 172.443, "maximum": 27965.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4366.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exploretreat ankle joint - 27620 - ", "code_information": [ { "code": "27620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6671.34, "discounted_cash": 2920.0, "minimum": 460.29, "maximum": 6671.34, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3977.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excision graft extremity", "code_information": [ { "code": "35903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35924.0, "discounted_cash": 2818.0, "minimum": 2677.2045, "maximum": 35924.01, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2769.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 35924.01, "discounted_cash": 2818.0, "minimum": 2677.2045, "maximum": 35924.01, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2769.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 } ] } ] }, { "description": "Drainage Of Finger Abscess", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22188.4, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 22188.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1400.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 135005.0, "minimum": 3407.0, "maximum": 261561.96, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 202508.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 130954.85, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 135005.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 258805.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 135005.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 135005.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 137705.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 175506.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 135005.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 209258.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 261561.96 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 209258.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 209258.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 216008.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 202508.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 136355.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 135005.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 213725.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 135005.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 135005.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 133654.95, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excision Of Tonsil Tags", "code_information": [ { "code": "42860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2959.0, "minimum": 374.23, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2548.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3018.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4142.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2811.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4586.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4586.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5918.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2988.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2959.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2929.52, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25226.0, "minimum": 3407.0, "maximum": 47204.52, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37840.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24470.09, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 25226.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 47204.52 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 25226.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 25226.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 25731.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32794.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25226.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 39101.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 30086.84 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 39101.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 39101.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 40363.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 37840.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 25479.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25226.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38982.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25226.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 25226.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24974.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16198.0, "minimum": 3407.0, "maximum": 29801.32, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24297.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15712.25, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 16198.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29801.32 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 16198.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 16198.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 16522.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21057.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16198.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 25107.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 23784.29 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 25107.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 25107.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 25917.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 24297.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 16360.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16198.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19292.8 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16198.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 16198.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16036.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5463.0, "minimum": 3189.549, "maximum": 9398.49, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8195.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5299.94, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9110.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5573.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7103.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8468.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7555.01 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8468.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8468.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 8742.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8195.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5518.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6233.44 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5463.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5409.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8129.0, "minimum": 882.2, "maximum": 14488.7, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 12194.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7885.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14249.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8292.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10568.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 12600.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14488.7 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 12600.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 12600.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 13007.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 12194.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8210.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13288.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8129.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8048.37, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30242.0, "minimum": 3407.0, "maximum": 56872.83, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 45364.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29335.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 30242.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 56872.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 30242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 30847.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39315.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 30242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 46876.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 46569.12 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 39150.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 9000.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 46876.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 46876.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 48388.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 45364.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 30545.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30242.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45434.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30242.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 30242.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29940.37, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5750.0, "minimum": 3407.0, "maximum": 10189.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8625.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5577.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9662.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5865.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7475.0, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8912.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 8828.93 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8912.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8912.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9200.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8625.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5807.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7213.91 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5750.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5692.5, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Stent Exchange W/Dilate", "code_information": [ { "code": "43276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21497.0, "discounted_cash": 5418.0, "minimum": 325.58, "maximum": 21497.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5480.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "standard_charge_algorithm": "Not To Exceed $4619", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 5639.0, "10th_percentile": 5639.0, "90th_percentile": 5639.0, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5526.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7585.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5147.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8398.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8398.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10836.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5472.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5418.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5364.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10389.0, "minimum": 3407.0, "maximum": 18899.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15584.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10078.2, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10389.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18605.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10389.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10389.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10597.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13506.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10389.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16104.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15523.93 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16104.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16104.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16623.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15584.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10493.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10389.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18899.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10389.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10389.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10286.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Egd Dilate Stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1712.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1220.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1746.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2397.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1627.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2654.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2654.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3425.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1729.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1695.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38114.0, "minimum": 1136.0, "maximum": 86850.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 57171.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 36971.07, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 38114.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 72045.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 38114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38876.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49548.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 59077.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6232.81 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 59077.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 59077.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 60983.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 57171.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 38495.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38114.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5961.54 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "per diem", "standard_charge_dollar": 1136.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38114.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 38114.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37733.36, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11089.0, "minimum": 3407.0, "maximum": 24260.0, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11089.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11089.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10978.31, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16633.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10756.52, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11089.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19953.61 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11089.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11089.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11310.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14415.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11089.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17188.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12830.37 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17188.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17188.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17742.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16633.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11200.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11089.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12033.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12492.0, "minimum": 3407.0, "maximum": 22657.98, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18738.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12117.43, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12492.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22657.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12492.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12492.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12742.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16239.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12492.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 19362.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19684.51 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 19362.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 19362.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19987.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18738.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12617.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12492.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15448.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12492.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12492.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12367.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30676.0, "minimum": 1323.3, "maximum": 57709.23, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46015.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29756.5, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 30676.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 57709.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 30676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 30676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31290.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39879.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 30676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 47548.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 3830.7 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 47548.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 47548.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 49082.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 46015.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 30983.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30676.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3284.73 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30676.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 30676.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30370.03, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9697.0, "minimum": 3407.0, "maximum": 19893.2, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14546.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9406.54, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17271.07 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9891.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12606.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 15031.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 10585.59 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 15031.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 15031.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15515.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14546.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9794.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10561.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9697.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9600.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6319.0, "minimum": 3407.0, "maximum": 13100.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9479.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6130.17, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10760.48 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6446.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8215.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9795.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6669.08 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9795.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9795.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10111.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9479.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6382.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5126.35 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6319.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6256.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EX ARMELBOW TUM DEEP < 5 CM", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19735.51, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19735.5, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5806.0, "minimum": 3407.0, "maximum": 14070.8, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5748.53, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8709.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5632.4, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9771.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5922.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7548.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9000.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5143.06 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9000.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9000.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9290.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8709.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5864.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4214.07 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5806.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXC BACK LES SC < 3 CM", "code_information": [ { "code": "21930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9627.08, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 9627.08, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26958.0, "minimum": 1136.0, "maximum": 50542.85, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40438.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26150.04, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 26958.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 50542.85 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 26958.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 26958.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 27497.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35046.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 26958.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 41786.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 41769.35 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 41786.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 41786.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 43134.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 40438.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 27228.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26958.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37573.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "per diem", "standard_charge_dollar": 1136.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26958.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 26958.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26689.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Back Les Sc 3 Cm/>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19634.1, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19634.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Gadoterate Meglumine Iv Soln 10 Mmol/20Ml (0.5 Mmol/Ml)", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00407294301", "type": "NDC" }, { "code": "A9575", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 719.99, "10th_percentile": 719.99, "90th_percentile": 719.99, "count": "1 through 10" } ] } ] }, { "description": "EXC BACK TUM DEEP 5 CM>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6418.05, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 6418.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4158.0, "minimum": 3407.0, "maximum": 11159.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 6237.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4033.57, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 6594.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4241.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 5405.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 6445.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 4101.57 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 6445.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 6445.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 6653.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 6237.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4199.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3473.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4158.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4116.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6368.0, "minimum": 3407.0, "maximum": 13585.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 9553.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6177.75, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10855.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 6496.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8279.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9871.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6934.59 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9871.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9871.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 10190.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 9553.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6432.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5969.66 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6368.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6305.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 1.1-2", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24573.07, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 24573.07, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 24573.1, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 24573.07, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10596.0, "minimum": 3407.0, "maximum": 20378.4, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15894.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10278.22, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10596.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19003.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10596.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10596.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10808.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13774.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10596.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16423.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16189.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16423.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16423.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16953.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15894.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10596.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13737.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10596.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10596.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10490.14, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 2.1-3", "code_information": [ { "code": "11643", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23042.43, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 23042.43, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 23042.4, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 23042.43, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8799.0, "minimum": 3407.0, "maximum": 18922.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 13199.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8535.44, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15540.08 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 8975.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11439.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 13639.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12867.03 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 13639.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 13639.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 14079.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 13199.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 8887.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11981.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 8799.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8711.43, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc feenl mal+mrg 3.1-4", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5717.88, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 5717.88, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Car Outp Meas Drg Car Cath Eval Cgen Hrt Defect", "code_information": [ { "code": "93598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 888.0, "minimum": 266.4, "maximum": 888.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.32 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 888.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Fth gr fr fccmnaxghf", "code_information": [ { "code": "15240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14995.3, "discounted_cash": 1841.0, "minimum": 374.23, "maximum": 14995.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 14995.31, "discounted_cash": 1841.0, "minimum": 374.23, "maximum": 14995.31, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ercp Remove Forgn Body Duct", "code_information": [ { "code": "43275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19814.9, "discounted_cash": 1712.0, "minimum": 325.58, "maximum": 19814.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3255.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1746.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2397.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1627.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2654.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2654.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3425.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1729.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1712.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1695.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc < 1.5 Cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 2893.0, "minimum": 215.99, "maximum": 14807.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3002.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9523.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2951.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4050.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2748.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4484.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4484.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5786.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2922.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 215.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2893.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2864.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45844.0, "minimum": 3407.0, "maximum": 86945.68, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 68766.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 44469.26, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 45844.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 86945.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 45844.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45844.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46761.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 59597.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 45844.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 71059.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 42368.32 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 71059.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 71059.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 73351.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 68766.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 46303.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45844.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27923.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45844.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 45844.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45386.15, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Radiation Therapy Mgmt 1/2 Fractions Only", "code_information": [ { "code": "77431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 433.0, "minimum": 129.9, "maximum": 433.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 403.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 433.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.0 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20992.0, "minimum": 3407.0, "maximum": 39041.73, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31488.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20362.34, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 20992.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 39041.73 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 20992.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 20992.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21411.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27289.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20992.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 32537.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19522.7 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 32537.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 32537.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 33587.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 31488.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 21202.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20992.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14141.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20992.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 20992.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20782.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Foot Bones - 28730 - OR36028730", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54465.0, "discounted_cash": 11458.0, "minimum": 460.29, "maximum": 54465.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16042.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22917.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc H-F-Nk-Sp B9+Marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Hand Joint", "code_information": [ { "code": "26843", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34484.1, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 34484.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Ex Arm/Elbow Tum Deep 5 Cm/>", "code_information": [ { "code": "24073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8374.21, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 8374.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Knuckle", "code_information": [ { "code": "26850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28056.9, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 28056.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Arm/Elbow Les Sc < 3 Cm", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 } ] } ] }, { "description": "EXC SHOULDER TUM DEEP 5 CM>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19735.5, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19735.51, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Knuckle With Graft", "code_information": [ { "code": "26852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28056.9, "discounted_cash": 6476.0, "minimum": 460.29, "maximum": 28056.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC FACE LES SC <2 CM", "code_information": [ { "code": "21011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19735.51, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19735.5, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Skn Hdrdnt Ing Complex", "code_information": [ { "code": "11463", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Face Tum Deep 2 Cm/>", "code_information": [ { "code": "21014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22188.4, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 22188.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Thigh/Knee Les Sc 3 Cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 19254.2, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc 1.5 Cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2592.0, "minimum": 374.23, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2751.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext b9+marg 2.1-3cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18511.4, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 18511.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 18511.4, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 18511.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Forearm Les Sc 3 Cm/>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32134.7, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 32134.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Tr-Ext B9+Marg 3.1-4 Cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC FOREARM TUM DEEP 3 CM>", "code_information": [ { "code": "25073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12700.54, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 12700.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12700.5, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 12700.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2206.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5185.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excise lip or cheek fold", "code_information": [ { "code": "40819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13157.01, "discounted_cash": 1384.0, "minimum": 243.24, "maximum": 13157.01, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1171.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1412.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1938.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2146.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2146.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2769.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1398.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1370.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 13157.0, "discounted_cash": 1384.0, "minimum": 243.24, "maximum": 13157.01, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1171.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1412.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1938.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1315.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2146.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2146.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2769.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1398.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1384.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1370.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10637.0, "minimum": 3407.0, "maximum": 19408.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15956.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10318.47, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10637.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19083.27 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10637.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10637.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10850.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13828.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10637.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16488.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 14504.8 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16488.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16488.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17020.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15956.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10743.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10637.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12613.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10637.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10637.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10531.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc hand tum deep 1.5 cm>", "code_information": [ { "code": "26113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12554.15, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 12554.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12554.2, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 12554.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excise Submaxillary Gland", "code_information": [ { "code": "42440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30613.3, "discounted_cash": 5283.0, "minimum": 374.23, "maximum": 30613.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4449.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5389.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7396.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5019.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10567.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5336.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5230.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7166.0, "minimum": 3407.0, "maximum": 25335.855, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10749.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6951.24, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12392.07 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7309.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9316.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 11107.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 9598.64 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 11107.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 11107.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11465.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10749.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 7237.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7904.62 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 7166.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7094.57, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXC HIPPELVIS LES SC < 3 CM", "code_information": [ { "code": "27047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4813.54, "discounted_cash": 2592.0, "minimum": 325.58, "maximum": 4813.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4813.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excision Of Anal Lesion(S)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16543.9, "discounted_cash": 2477.0, "minimum": 243.24, "maximum": 16543.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1879.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2526.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3468.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2353.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 3839.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4954.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2502.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2477.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2452.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13090.0, "minimum": 3407.0, "maximum": 30522.435, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 13352.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17017.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13090.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 20289.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11445.6 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 20289.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 20289.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 20944.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 19635.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 13221.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13090.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15111.2 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13090.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 13090.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12959.3, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19635.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12697.49, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 13090.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23810.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 13090.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 13090.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc S/N/H/F/G Mal+Mrg 3.1-4", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25122.6, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 25122.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1465.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10941.0, "minimum": 3189.549, "maximum": 19668.75, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 16412.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10613.16, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10941.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19668.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10941.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10941.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11160.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14223.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10941.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 16959.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 16991.84 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 16959.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 16959.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 17506.19, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 16412.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11050.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16263.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10941.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10941.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10831.99, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc Shoulder Les Sc 3 Cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21440.0, "minimum": 3407.0, "maximum": 39906.01, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32160.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20797.29, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 21440.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 39906.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 21440.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 21440.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 21869.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27872.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21440.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 33232.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 33496.47 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 33232.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 33232.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 34304.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 32160.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 21654.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21440.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36987.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 21440.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 21440.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21226.1, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc skin abd add-on", "code_information": [ { "code": "15847", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23091.1, "minimum": 511.0, "maximum": 23091.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] }, { "setting": "outpatient", "gross_charge": 23091.1, "minimum": 511.0, "maximum": 23091.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Exc Tr-Ext B9+Marg >4.0 Cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19634.1, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19634.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18289.0, "minimum": 3407.0, "maximum": 35419.6, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27434.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17741.11, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 18289.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 33833.02 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 18289.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 18289.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 18655.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23776.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18289.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 28349.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 26612.84 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 28349.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 28349.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 29263.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 27434.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 18472.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18289.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23843.7 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18289.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 18289.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18106.9, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14422.35, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 14422.35, "payers_information": [ { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 14422.4, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 14422.35, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2255.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fth grf fr sal 20 sq cm<", "code_information": [ { "code": "15220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18729.74, "discounted_cash": 1841.0, "minimum": 325.58, "maximum": 18729.74, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 18729.7, "discounted_cash": 1841.0, "minimum": 325.58, "maximum": 18729.74, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16108.6, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 16108.61, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 16108.61, "discounted_cash": 632.0, "minimum": 243.24, "maximum": 16108.61, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excise anal ext tagpapilla", "code_information": [ { "code": "46220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19735.51, "discounted_cash": 1068.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1879.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1495.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2136.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1057.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 19735.5, "discounted_cash": 1068.0, "minimum": 243.24, "maximum": 19735.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1879.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1495.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2136.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1057.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28755 - OR36028755", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25122.6, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 25122.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2751.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4223) Infusion Supplies W/O Pump", "code_information": [ { "code": "A4223", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 1.69, "10th_percentile": 1.69, "90th_percentile": 1.69, "count": "1 through 10" } ] } ] }, { "description": "Excise Intrspinl Lesion Lmbr", "code_information": [ { "code": "63267", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41719.1, "discounted_cash": 6476.0, "minimum": 1704.0, "maximum": 41719.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5936.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11254.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Finger Joint", "code_information": [ { "code": "26860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22188.4, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 22188.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Excision Radial Head", "code_information": [ { "code": "24130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19254.2, "discounted_cash": 2920.0, "minimum": 460.29, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7240.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion of foot bones - 28740 - ", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14242.69, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 14242.69, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 14242.7, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 14242.69, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exploration of chest", "code_information": [ { "code": "39010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12700.54, "minimum": 1477.0, "maximum": 12700.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6631.35 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 } ] }, { "setting": "outpatient", "gross_charge": 12700.5, "minimum": 1477.0, "maximum": 12700.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6631.35 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 } ] } ] }, { "description": "Explore Parathyroid Glands", "code_information": [ { "code": "60500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29660.7, "discounted_cash": 5283.0, "minimum": 374.23, "maximum": 29660.7, "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5230.72, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5390.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5389.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7396.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5019.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10567.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5336.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4316.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12233.0, "minimum": 3407.0, "maximum": 22158.56, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18349.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11866.11, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12233.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22158.56 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12477.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15903.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 18961.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 13206.74 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 18961.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 18961.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19572.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18349.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12355.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13750.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12233.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12110.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exploretreat ankle joint - 27610 - ", "code_information": [ { "code": "27610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12286.5, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 12286.53, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3977.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 12286.53, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 12286.53, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3977.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4701.0, "minimum": 3357.42, "maximum": 9000.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 7052.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4560.61, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 7641.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 4795.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 6112.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 7287.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5315.59 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 7287.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 7287.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 7522.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 7052.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 4748.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5537.86 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 4701.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4654.64, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Exploretreat finger joint", "code_information": [ { "code": "26080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11815.8, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 11815.77, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 11815.77, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 11815.77, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5704.0, "minimum": 3407.0, "maximum": 14556.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8556.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5532.97, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9573.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5818.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7415.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 8841.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5336.15 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 8841.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 8841.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9126.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8556.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5761.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4687.25 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5704.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5647.05, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11516.0, "minimum": 3357.42, "maximum": 27255.78, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17274.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11170.71, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 11516.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20776.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 11516.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 11516.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 11746.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14971.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11516.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 17850.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 12058.87 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 17850.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 17850.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 18425.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 17274.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 11631.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11516.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10307.9 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11516.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 11516.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11401.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10024.0, "minimum": 3407.0, "maximum": 21834.0, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 15036.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9723.77, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 10024.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17901.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 10024.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 10024.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 10224.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13031.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10024.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 15537.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 11796.05 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 15537.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 15537.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 16039.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 15036.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 10124.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10024.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10156.1 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10024.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 10024.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9924.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "GRAFT; EAR CARTILAGE, AUTOGRAFT", "code_information": [ { "code": "21235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22831.16, "discounted_cash": 5283.0, "minimum": 728.83, "maximum": 22831.16, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4449.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5389.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7396.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5019.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10567.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5336.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 728.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5230.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 22831.2, "discounted_cash": 5283.0, "minimum": 728.83, "maximum": 22831.16, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4449.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5389.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7396.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5019.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8189.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10567.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5336.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 728.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5283.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5230.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9461.0, "minimum": 1764.4, "maximum": 20412.42, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 14192.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9177.78, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16816.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 9650.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12300.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 14665.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 15688.42 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 14665.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 14665.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 15138.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 14192.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 9556.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15651.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 9461.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9367.01, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16543.9, "discounted_cash": 1435.0, "minimum": 243.24, "maximum": 16543.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1259.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1483.62, "minimum": 40.0, "maximum": 1483.62, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.84 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12011.0, "minimum": 3407.0, "maximum": 21731.87, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11651.35, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 12011.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21731.87 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 12011.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 12011.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 12251.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15615.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12011.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 18618.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 19363.57 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 18618.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 18618.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 19218.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 18017.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 12131.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12011.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11637.4 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12011.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 12011.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11891.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5816.0, "minimum": 3407.0, "maximum": 13585.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9789.53 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 5932.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 7560.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 9014.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 6109.45 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 9014.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 9014.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 9305.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 8724.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 5874.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5172.62 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 5816.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5757.87, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 8724.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5641.55, "additional_payer_notes": "97.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14639.0, "minimum": 2954.39, "maximum": 26796.34, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 21958.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14200.02, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 14639.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26796.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 14639.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 14639.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 14931.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19030.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14639.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 22690.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 5795.66 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 22690.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 22690.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 23422.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 21958.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 14785.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14639.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2954.39 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14639.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 14639.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14492.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Ankle Joint Open", "code_information": [ { "code": "27870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63424.3, "discounted_cash": 11458.0, "minimum": 460.29, "maximum": 63424.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8906.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11687.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16042.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10885.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17761.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22917.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11573.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 460.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11458.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11344.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Big Toe Joint - 28750 - OR36028750", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28056.9, "discounted_cash": 6476.0, "minimum": 374.23, "maximum": 28056.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6671.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6605.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9066.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6152.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10038.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12952.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6541.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6476.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6411.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Fusion Of Knuckle Joint", "code_information": [ { "code": "26516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25122.6, "discounted_cash": 2920.0, "minimum": 243.24, "maximum": 25122.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2953.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6904.0, "minimum": 3407.0, "maximum": 14070.8, "payers_information": [ { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4058.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 10356.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6697.48, "additional_payer_notes": "97.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11887.8 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 7042.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8976.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Choice Of Alabama (HEALTHNET)", "plan_name": "Health Choice Of Alabama (HEALTHNET) Commercial", "methodology": "case rate", "standard_charge_dollar": 10702.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "case rate", "standard_charge_dollar": 7869.69 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13050.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "case rate", "standard_charge_dollar": 10702.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "case rate", "standard_charge_dollar": 10702.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "National Healthcare Solutions, INC", "plan_name": "National Healthcare Solutions Commercial", "methodology": "case rate", "standard_charge_dollar": 11047.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "case rate", "standard_charge_dollar": 10356.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4278.67 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "case rate", "standard_charge_dollar": 6973.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7098.65 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 3407.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "case rate", "standard_charge_dollar": 6904.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6835.57, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Glycopyrrolate Inj 0.4 Mg/2Ml (0.2 Mg/Ml)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00517460225", "type": "NDC" }, { "code": "J1596", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 17.71, "10th_percentile": 17.71, "90th_percentile": 17.71, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4213) 20+ Cc Syringe Only", "code_information": [ { "code": "A4213", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 0.4, "10th_percentile": 0.4, "90th_percentile": 0.4, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A4649) Surgical Supplies - A4649 - RU272005", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 13.56, "10th_percentile": 13.56, "90th_percentile": 13.56, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1726) Catheter Balloon Dilat Non-Vascular", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 221.65, "10th_percentile": 221.65, "90th_percentile": 221.65, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1760) Closure Device Vascular", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 26.7, "median_amount": 728.91, "10th_percentile": 728.91, "90th_percentile": 728.91, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1887) Catheter Guiding", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 299.0, "10th_percentile": 299.0, "90th_percentile": 299.0, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1894) Intrducr/Sheath Not Guid Non-Lasr", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 67.5, "10th_percentile": 67.5, "90th_percentile": 67.5, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell A6531) Compression Stocking Bk30-40", "code_information": [ { "code": "A6531", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 61.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 17.39, "10th_percentile": 17.39, "90th_percentile": 33.9, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C2625) Stent Non-Cor Temp W/Deliv System", "code_information": [ { "code": "C2625", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 26.7, "median_amount": 447.76, "10th_percentile": 447.76, "90th_percentile": 447.76, "count": "1 through 10" } ] } ] }, { "description": "Hc (Sup Shell C1713) Anchr/Screw Oppos Bn-Bn/Sft Tiss-Bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 40.0, "median_amount": 4284.0, "10th_percentile": 4284.0, "90th_percentile": 4284.0, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 26.7, "median_amount": 6178.77, "10th_percentile": 2674.54, "90th_percentile": 15132.88, "count": "1 through 10" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3036.41, "discounted_cash": 212.0, "minimum": 108.83, "maximum": 3036.41, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 425.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 681.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 681.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 210.82, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 217.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 212.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 202.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 330.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 330.07, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3036.41, "discounted_cash": 699.0, "minimum": 591.93, "maximum": 3036.41, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 713.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 664.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1084.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1084.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1399.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 706.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 681.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 681.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 692.66, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp & Postprocess Supervision (76376)", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.0, "minimum": 111.25, "maximum": 860.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 725.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 363.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.0 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4041.79, "discounted_cash": 809.0, "minimum": 374.23, "maximum": 4041.79, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 942.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 825.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1133.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 769.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1618.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 817.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 801.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actigraphy Testing, 3-14 Day", "code_information": [ { "code": "95803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1141.9, "discounted_cash": 52.0, "minimum": 50.0175, "maximum": 1141.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.7, "discounted_cash": 15.0, "minimum": 10.72, "maximum": 356.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.33, "discounted_cash": 16.0, "minimum": 11.8, "maximum": 304.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11.0, "minimum": 8.38, "maximum": 138.93, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.82, "discounted_cash": 12.0, "minimum": 9.0, "maximum": 133.82, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.8, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.98, "discounted_cash": 16.0, "minimum": 9.19, "maximum": 371.98, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Resistance By Impulse Oscillometry", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 455.0, "discounted_cash": 114.0, "minimum": 27.14, "maximum": 455.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.68, "discounted_cash": 7.0, "minimum": 5.57, "maximum": 68.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.89, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 300.0, "minimum": 40.0, "maximum": 962.28, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 210.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 285.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 465.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 465.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 345.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 297.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.86, "discounted_cash": 7.0, "minimum": 5.47, "maximum": 84.86, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.47 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28791.9, "discounted_cash": 6961.0, "minimum": 517.61, "maximum": 28791.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20846.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9523.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7100.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9745.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6613.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10790.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10790.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13922.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7030.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 517.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 4997.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6961.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6891.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.0, "discounted_cash": 14.0, "minimum": 9.92, "maximum": 195.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate/ Reconstuct Atria, W Othr Proced Limitd", "code_information": [ { "code": "33257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.79, "minimum": 160.437, "maximum": 534.79, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 534.79 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 534.79 } ] } ] }, { "description": "Hc Amino Acids, 2-5 Quant", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.08, "discounted_cash": 19.0, "minimum": 13.727, "maximum": 228.08, "payers_information": [ { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.3, "discounted_cash": 18.0, "minimum": 12.88, "maximum": 94.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect Local Flap", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14461.4, "discounted_cash": 2920.0, "minimum": 374.23, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2801.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Modlg Antb", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12.0, "minimum": 8.435, "maximum": 60.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Androstanediol Glucuronide", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.87, "discounted_cash": 28.0, "minimum": 16.05, "maximum": 324.87, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.15, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.18 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel 21 Hydroxylase Deficiency", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.8, "discounted_cash": 86.0, "minimum": 40.0, "maximum": 1192.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 60.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13594.2, "discounted_cash": 2818.0, "minimum": 77.72, "maximum": 13594.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Activity Therapy 45Min Or More, Mentl Disabl Php", "code_information": [ { "code": "G0176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "minimum": 53.1, "maximum": 177.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.0 } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7281.87, "discounted_cash": 2818.0, "minimum": 116.87, "maximum": 7281.87, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 116.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2713.26, "discounted_cash": 1841.0, "minimum": 374.23, "maximum": 36859.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2713.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17087.2, "discounted_cash": 2818.0, "minimum": 60.06, "maximum": 17087.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.01, "discounted_cash": 41.0, "minimum": 20.5, "maximum": 375.01, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.36, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.27, "discounted_cash": 14.0, "minimum": 10.22, "maximum": 445.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.22 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Scr Auditory Potential W/Stimuli Auto Alys", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 44.14, "maximum": 273.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.14 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.0 } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4712.18, "discounted_cash": 2818.0, "minimum": 14.64, "maximum": 4712.18, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1074.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4712.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.95, "discounted_cash": 6.0, "minimum": 4.88, "maximum": 90.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens, Mlc, Each", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.79, "discounted_cash": 40.0, "minimum": 28.11, "maximum": 115.79, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Albumin Ischemia Modified", "code_information": [ { "code": "82045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.33, "discounted_cash": 33.0, "minimum": 23.75, "maximum": 323.33, "payers_information": [ { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.75 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.76, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.95, "discounted_cash": 4.0, "minimum": 3.32, "maximum": 70.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 868.56, "discounted_cash": 5.0, "minimum": 3.65, "maximum": 868.56, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 385.64, "10th_percentile": 385.64, "90th_percentile": 4242.05, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 521.14, "10th_percentile": 521.14, "90th_percentile": 2605.68, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050.0, "discounted_cash": 64.0, "minimum": 5.48, "maximum": 1050.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 44.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 60.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.82, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc 2D Tee W Or W/O Fol W/Con,In", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3909.76, "discounted_cash": 699.0, "minimum": 591.93, "maximum": 7712.57, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 591.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3909.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 713.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 979.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 664.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1084.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1084.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1399.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 706.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 699.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 692.66, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.05, "discounted_cash": 14.0, "minimum": 10.12, "maximum": 224.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - 80337 - 30100422", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.51, "minimum": 6.23, "maximum": 332.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.3, "discounted_cash": 18.0, "minimum": 12.88, "maximum": 94.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.18, "discounted_cash": 13.0, "minimum": 9.4, "maximum": 171.18, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13750.0, "discounted_cash": 504.0, "minimum": 97.0, "maximum": 13750.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 515.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 352.8, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 352.8, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 478.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 579.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 504.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 498.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.49, "discounted_cash": 179.0, "minimum": 106.047, "maximum": 353.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 277.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 277.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 353.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 353.49 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 179.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 177.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ambl Bld Press W/Tape/Disk 24/>Hr Alys W/Reprt", "code_information": [ { "code": "93788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 996.0, "discounted_cash": 118.0, "minimum": 87.11, "maximum": 996.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 112.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831.3, "minimum": 249.39, "maximum": 831.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 831.3 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Hc Acth Stimj Panel 3 Beta-Hydroxydehyd Defncy", "code_information": [ { "code": "80406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1073.5, "discounted_cash": 78.0, "minimum": 40.0, "maximum": 1073.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 54.78, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.78, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.35, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.48, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.68, "discounted_cash": 13.0, "minimum": 9.7, "maximum": 245.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 911.8, "discounted_cash": 118.0, "minimum": 54.44, "maximum": 911.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 112.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366.0, "discounted_cash": 32.0, "minimum": 16.05, "maximum": 366.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.83, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.83 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 32.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,No Reprog", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.54, "discounted_cash": 118.0, "minimum": 82.062, "maximum": 273.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 112.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.54 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 592.13, "discounted_cash": 249.0, "minimum": 54.44, "maximum": 592.13, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 349.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 499.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.76, "discounted_cash": 12.0, "minimum": 8.43, "maximum": 61.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anesth Vag Delivery, Epidural", "code_information": [ { "code": "01967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1151.33, "minimum": 30.5, "maximum": 1151.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.5 } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Elisa", "code_information": [ { "code": "86051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.65, "discounted_cash": 11.0, "minimum": 8.07, "maximum": 57.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.07 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.32, "discounted_cash": 41.0, "minimum": 39.691, "maximum": 221.32, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.36, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4234.33, "discounted_cash": 2818.0, "minimum": 106.77, "maximum": 4234.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4234.33, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.82, "discounted_cash": 52.0, "minimum": 3.77, "maximum": 320.02, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.3, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detection Polyval If", "code_information": [ { "code": "87300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.86, "discounted_cash": 11.0, "minimum": 8.38, "maximum": 186.86, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5349.95, "discounted_cash": 2818.0, "minimum": 160.17, "maximum": 5349.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5349.95, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum W Drugs", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.07, "discounted_cash": 398.0, "minimum": 9.0, "maximum": 200.07, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200.07, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 898.55, "discounted_cash": 195.0, "minimum": 17.79, "maximum": 898.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 449.28, "10th_percentile": 449.28, "90th_percentile": 449.28, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 302.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 302.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 390.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 199.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 199.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 193.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8725.67, "discounted_cash": 2818.0, "minimum": 60.06, "maximum": 17087.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2744.04, "discounted_cash": 311.0, "minimum": 26.69, "maximum": 2744.04, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Recombinant/Purified Compnt Ea", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.89, "discounted_cash": 17.0, "minimum": 12.551, "maximum": 91.89, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "101.00% 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Biopsy Sing/Mult", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4447.44, "discounted_cash": 1068.0, "minimum": 243.24, "maximum": 4447.44, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1238.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1495.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2136.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1057.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1904.34, "discounted_cash": 311.0, "minimum": 47.45, "maximum": 1904.34, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 492.43, "discounted_cash": 64.0, "minimum": 40.0, "maximum": 492.43, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.08 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I High Definition Panel Qual", "code_information": [ { "code": "86832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 323.0, "minimum": 33.42, "maximum": 884.17, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 226.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 330.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 307.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 372.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 320.51, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1963.21, "discounted_cash": 311.0, "minimum": 78.61, "maximum": 1963.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543.0, "discounted_cash": 16.0, "minimum": 11.8, "maximum": 543.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii Phenotype Panel Qual", "code_information": [ { "code": "86831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.0, "discounted_cash": 81.0, "minimum": 33.42, "maximum": 605.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 57.32, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.32, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 77.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 126.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 126.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.16, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 81.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 499.93, "discounted_cash": 15.0, "minimum": 10.53, "maximum": 499.93, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 221.97, "10th_percentile": 221.97, "90th_percentile": 443.94, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.53 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.9, "discounted_cash": 22.0, "minimum": 15.5, "maximum": 114.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.43, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.18, "discounted_cash": 12.0, "minimum": 8.43, "maximum": 489.18, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspirat/Injection Ganglion Cyst(S)", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 604.86, "discounted_cash": 273.0, "minimum": 181.458, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13636.3, "discounted_cash": 2920.0, "minimum": 325.58, "maximum": 25580.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1689.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2978.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4088.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2774.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4526.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5840.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2949.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2920.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2891.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 10.0, "minimum": 7.12, "maximum": 82.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.49, "discounted_cash": 5.0, "minimum": 3.62, "maximum": 575.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.62 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analysis, Tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 656.29, "discounted_cash": 152.0, "minimum": 51.55, "maximum": 656.29, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653.25, "discounted_cash": 11.0, "minimum": 4.74, "maximum": 653.25, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.29 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "discounted_cash": 18.0, "minimum": 12.64, "maximum": 400.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.77, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5857.94, "discounted_cash": 2818.0, "minimum": 160.17, "maximum": 5857.94, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4680.92, "discounted_cash": 1841.0, "minimum": 1404.276, "maximum": 4680.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2578.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2854.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3683.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Carbamazepine Free", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.58, "discounted_cash": 13.0, "minimum": 9.27, "maximum": 143.58, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13428.4, "discounted_cash": 2818.0, "minimum": 142.02, "maximum": 13428.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 457.05, "discounted_cash": 249.0, "minimum": 54.44, "maximum": 457.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 349.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 457.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 457.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay L/S Ratio", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.29, "discounted_cash": 21.0, "minimum": 15.39, "maximum": 368.29, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8470.26, "discounted_cash": 4966.0, "minimum": 286.51, "maximum": 8470.26, "payers_information": [ { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4718.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8470.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5016.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4916.75, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5251.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5065.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6952.97, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.21, "discounted_cash": 145.0, "minimum": 54.44, "maximum": 1222.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Lipoprotein Pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.45, "discounted_cash": 46.0, "minimum": 32.41, "maximum": 264.45, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 32.42, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.42, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.26, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 45.85, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.75, "discounted_cash": 42.0, "minimum": 13.3, "maximum": 67.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 29.49, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.49, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.21, "discounted_cash": 145.0, "minimum": 54.44, "maximum": 1222.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Adp & Amp", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.29, "discounted_cash": 25.0, "minimum": 16.05, "maximum": 385.29, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 311.0, "minimum": 48.05, "maximum": 1758.55, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.21, "discounted_cash": 145.0, "minimum": 137.7785, "maximum": 1222.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Alcohol (Ethanol) Breath", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.44, "discounted_cash": 30.0, "minimum": 15.5, "maximum": 126.44, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.08, "discounted_cash": 8.0, "minimum": 6.05, "maximum": 253.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 8.65, "10th_percentile": 6.92, "90th_percentile": 126.54, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 109.63, "10th_percentile": 6.06, "90th_percentile": 112.37, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 99.29, "10th_percentile": 99.29, "90th_percentile": 151.85, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.0, "discounted_cash": 34.0, "minimum": 29.66, "maximum": 154.0, "payers_information": [ { "payer_name": "Americas Choice Provider Network", "plan_name": "Americas Choice Provider Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.83 }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.34 }, { "payer_name": "Compone", "plan_name": "Compone Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 53.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 53.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Novanet", "plan_name": "Novanet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.91 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.68 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Provider Network of America", "plan_name": "Provider Network of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 68.69 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.0, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.38 }, { "payer_name": "Zelis(fka Stratose)", "plan_name": "Zelis(fka Stratose) Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.91 } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.22, "discounted_cash": 40.0, "minimum": 16.05, "maximum": 381.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.52 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 40.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.0, "discounted_cash": 325.0, "minimum": 33.42, "maximum": 846.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 228.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 332.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 309.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.67, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 322.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918.45, "discounted_cash": 152.0, "minimum": 3.62, "maximum": 918.45, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.24, "discounted_cash": 25.0, "minimum": 16.05, "maximum": 272.24, "payers_information": [ { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.38, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.51, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh Phenotype", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1512.36, "discounted_cash": 33.0, "minimum": 5.42, "maximum": 1512.36, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.01, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.53, "discounted_cash": 21.0, "minimum": 14.76, "maximum": 130.53, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.02, "discounted_cash": 52.0, "minimum": 3.77, "maximum": 320.02, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.3, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin, Titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.9, "discounted_cash": 8.0, "minimum": 5.64, "maximum": 256.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.27, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - 80345 - 30100326", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "minimum": 15.5, "maximum": 166.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.0, "discounted_cash": 152.0, "minimum": 3.62, "maximum": 918.45, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood Freeze & Thaw Per Unit", "code_information": [ { "code": "86932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 843.0, "discounted_cash": 33.0, "minimum": 31.673, "maximum": 843.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.01, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.03, "discounted_cash": 5.0, "minimum": 3.85, "maximum": 277.03, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.28, "discounted_cash": 12.0, "minimum": 8.46, "maximum": 698.28, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 310.04, "10th_percentile": 310.04, "90th_percentile": 310.04, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1813.55, "10th_percentile": 1813.55, "90th_percentile": 1813.55, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins & Agglutinins, Incubated", "code_information": [ { "code": "86941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 12.0, "minimum": 5.48, "maximum": 186.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.53, "discounted_cash": 23.0, "minimum": 14.0, "maximum": 149.53, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.19, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.68, "discounted_cash": 5.0, "minimum": 4.03, "maximum": 127.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Hemolysins/Agglutinins Auto", "code_information": [ { "code": "86940", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.0, "discounted_cash": 8.0, "minimum": 5.48, "maximum": 172.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.0, "discounted_cash": 26.0, "minimum": 16.05, "maximum": 410.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.81, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.49, "discounted_cash": 10.0, "minimum": 4.74, "maximum": 75.49, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1514.3, "discounted_cash": 319.0, "minimum": 14.0, "maximum": 1514.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 447.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 303.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 639.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Chloramphenicol", "code_information": [ { "code": "82415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.0, "discounted_cash": 12.0, "minimum": 8.86, "maximum": 201.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7056.05, "discounted_cash": 659.0, "minimum": 243.24, "maximum": 20713.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 923.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 626.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1022.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1022.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1319.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 653.03, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum Dilutn", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.61, "discounted_cash": 25.0, "minimum": 12.0, "maximum": 99.61, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Chromium", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.03, "discounted_cash": 20.0, "minimum": 14.0, "maximum": 460.03, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.32, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.05, "minimum": 48.615, "maximum": 162.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 162.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 162.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 162.05 } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Den Grad Sep", "code_information": [ { "code": "86972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.66, "discounted_cash": 152.0, "minimum": 17.0, "maximum": 231.66, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.03, "discounted_cash": 12.0, "minimum": 8.68, "maximum": 165.03, "payers_information": [ { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 99.02, "10th_percentile": 99.02, "90th_percentile": 99.02, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2504.13, "discounted_cash": 1841.0, "minimum": 243.24, "maximum": 2504.13, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1878.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1749.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2504.13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1859.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 2504.13 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 2504.13 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1841.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1823.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Cath Prolngd Nfs Ther Chemotx Cutdown", "code_information": [ { "code": "36640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1057.85, "discounted_cash": 2818.0, "minimum": 243.24, "maximum": 1057.85, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1057.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1057.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1057.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1057.85, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.8, "discounted_cash": 4.0, "minimum": 3.24, "maximum": 256.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.25, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.59, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc 3D Rendering W/Interp&Postproc Diff Work Statio", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1015.03, "minimum": 117.73, "maximum": 1015.03, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 725.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 117.73 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 363.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.0 } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2992.42, "minimum": 511.0, "maximum": 2992.42, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 630.0, "minimum": 286.51, "maximum": 2535.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 642.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 882.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 598.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 976.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 976.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1260.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 636.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 630.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 623.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.53, "discounted_cash": 5.0, "minimum": 3.58, "maximum": 265.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 132.77, "10th_percentile": 132.76, "90th_percentile": 132.77, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 117.9, "10th_percentile": 21.1, "90th_percentile": 138.05, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 79.66, "10th_percentile": 77.71, "90th_percentile": 1013.36, "count": "11" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 15.74, "10th_percentile": 15.74, "90th_percentile": 15.74, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.07, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3818.85, "discounted_cash": 809.0, "minimum": 374.23, "maximum": 3818.85, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 942.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 825.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1133.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 769.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1254.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1618.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 817.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 374.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 809.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 801.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7682.65, "discounted_cash": 659.0, "minimum": 243.24, "maximum": 7682.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2498.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 923.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 626.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1022.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1022.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1319.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 659.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 653.03, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4555.76, "discounted_cash": 311.0, "minimum": 21.34, "maximum": 4555.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.83, "discounted_cash": 6.0, "minimum": 4.52, "maximum": 134.83, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13098.7, "minimum": 366.34, "maximum": 13098.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13098.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9523.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 366.34 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 560.5, "discounted_cash": 145.0, "minimum": 55.45, "maximum": 560.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspiration And/Or Injection Thyroid Cyst", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1003.0, "discounted_cash": 632.0, "minimum": 300.9, "maximum": 1003.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1003.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.23, "discounted_cash": 18.0, "minimum": 12.63, "maximum": 296.23, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholinesterase Assay", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.78, "discounted_cash": 12.0, "minimum": 8.6, "maximum": 218.78, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.4, "discounted_cash": 52.0, "minimum": 50.0175, "maximum": 559.4, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.56, "discounted_cash": 19.0, "minimum": 13.74, "maximum": 219.56, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Doxepin - G0480 - 30100409", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 265.6, "discounted_cash": 114.0, "minimum": 27.8, "maximum": 265.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 573.39, "discounted_cash": 118.0, "minimum": 54.44, "maximum": 573.39, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 112.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.15, "discounted_cash": 3.0, "minimum": 2.75, "maximum": 283.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.27, "discounted_cash": 24.0, "minimum": 16.05, "maximum": 347.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.12, "discounted_cash": 41.0, "minimum": 39.691, "maximum": 340.12, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 41.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 41.36, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 934.6, "discounted_cash": 118.0, "minimum": 54.44, "maximum": 934.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 112.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.65, "discounted_cash": 16.0, "minimum": 11.66, "maximum": 186.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Aep Hearing Status Deter Broadband Stimuli I&R", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810.0, "discounted_cash": 192.0, "minimum": 41.61, "maximum": 810.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 183.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 298.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 298.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 192.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 190.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1131.35, "discounted_cash": 249.0, "minimum": 54.44, "maximum": 1131.35, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 349.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 499.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.0, "discounted_cash": 64.0, "minimum": 40.0, "maximum": 703.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.08 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.85, "discounted_cash": 11.0, "minimum": 8.38, "maximum": 198.85, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply/Remove Cranial Fix Dev", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5714.24, "discounted_cash": 1435.0, "minimum": 325.58, "maximum": 5714.24, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3070.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1463.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2009.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1363.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2870.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1449.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1435.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1420.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Flurazepam - 80346 - 30100014", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Single", "code_information": [ { "code": "87450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.7, "minimum": 9.19, "maximum": 420.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Arc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.06, "discounted_cash": 319.0, "minimum": 2.68, "maximum": 1514.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 303.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 309.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.14, "discounted_cash": 38.0, "minimum": 16.05, "maximum": 432.14, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.41, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.03 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.23, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.37, "discounted_cash": 17.0, "minimum": 12.34, "maximum": 515.37, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 509.11, "discounted_cash": 16.0, "minimum": 11.73, "maximum": 509.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Cold Agglutinin Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.48, "discounted_cash": 8.0, "minimum": 5.64, "maximum": 116.48, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 681.35, "discounted_cash": 16.0, "minimum": 11.46, "maximum": 681.35, "payers_information": [ { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.84, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein; Amniotic", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.0, "discounted_cash": 17.0, "minimum": 11.9, "maximum": 151.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.38, "discounted_cash": 152.0, "minimum": 33.92, "maximum": 427.38, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.5, "discounted_cash": 29.0, "minimum": 16.05, "maximum": 319.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.99, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 4.0, "minimum": 3.32, "maximum": 85.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 801.85, "discounted_cash": 822.0, "minimum": 240.555, "maximum": 801.85, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 801.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 801.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 801.85 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 801.85, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 538.52, "discounted_cash": 152.0, "minimum": 30.0, "maximum": 538.52, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Angiotensin Ii", "code_information": [ { "code": "82163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.25, "discounted_cash": 20.0, "minimum": 14.36, "maximum": 339.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.2, "discounted_cash": 17.0, "minimum": 12.54, "maximum": 271.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Complx/Prog", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 647.3, "discounted_cash": 84.0, "minimum": 80.6075, "maximum": 647.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 131.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 131.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreat,Serum Diff Rbc Abso", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.29, "discounted_cash": 52.0, "minimum": 16.0, "maximum": 138.29, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.83, "discounted_cash": 13.0, "minimum": 9.57, "maximum": 285.83, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 126.91, "10th_percentile": 126.91, "90th_percentile": 126.91, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Imipramine - G0480 - 30100017", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Analyze Neurostim,Simple/Prog", "code_information": [ { "code": "95971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 687.25, "discounted_cash": 84.0, "minimum": 80.6075, "maximum": 687.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 131.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 131.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 369.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 84.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Chem Or Drugs", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.4, "discounted_cash": 52.0, "minimum": 17.0, "maximum": 177.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 81.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 52.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 52.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cocaine - 80353 - 30100327", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 6.23, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 753.72, "discounted_cash": 6.0, "minimum": 4.52, "maximum": 753.72, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 6.41, "10th_percentile": 6.41, "90th_percentile": 452.23, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 376.86, "10th_percentile": 376.86, "90th_percentile": 376.86, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 334.65, "10th_percentile": 4.53, "90th_percentile": 334.65, "count": "32" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21210.4, "discounted_cash": 2818.0, "minimum": 120.11, "maximum": 21210.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment/Enzym", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.6, "discounted_cash": 152.0, "minimum": 17.0, "maximum": 151.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 151.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.71, "discounted_cash": 13.0, "minimum": 9.37, "maximum": 154.71, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.37, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.37, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.81, "discounted_cash": 14.0, "minimum": 10.28, "maximum": 228.81, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13428.4, "discounted_cash": 2818.0, "minimum": 188.22, "maximum": 13428.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 915.84, "minimum": 274.752, "maximum": 915.84, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 810.64 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Hc Assay Of Cryofibrinogen", "code_information": [ { "code": "82585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.58, "discounted_cash": 14.0, "minimum": 9.89, "maximum": 299.58, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.82, "discounted_cash": 6.0, "minimum": 4.82, "maximum": 333.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 162.84, "10th_percentile": 162.84, "90th_percentile": 166.91, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 83.49, "10th_percentile": 56.35, "90th_percentile": 121.55, "count": "23" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 132.11, "10th_percentile": 13.71, "90th_percentile": 132.11, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23151.1, "discounted_cash": 4966.0, "minimum": 19.29, "maximum": 23151.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5251.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5065.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6952.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4718.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9932.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5016.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4916.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1544.0, "discounted_cash": 273.0, "minimum": 260.2525, "maximum": 1544.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 628.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.43, "discounted_cash": 21.0, "minimum": 15.19, "maximum": 304.43, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 131.87, "10th_percentile": 131.87, "90th_percentile": 131.87, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipoprotein(A)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.24, "discounted_cash": 14.0, "minimum": 10.02, "maximum": 153.24, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8725.67, "discounted_cash": 2818.0, "minimum": 204.53, "maximum": 8725.67, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 204.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2370.55, "discounted_cash": 311.0, "minimum": 21.34, "maximum": 2370.55, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - 80320 - 30100071", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.17, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.68, "discounted_cash": 6.0, "minimum": 4.62, "maximum": 231.68, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4369.13, "minimum": 135.26, "maximum": 4369.13, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4369.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.26 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3018.4, "discounted_cash": 311.0, "minimum": 21.34, "maximum": 3018.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 435.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 295.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 482.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 622.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 311.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 308.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.17, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Manganese", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.4, "discounted_cash": 26.0, "minimum": 14.0, "maximum": 268.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.65, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13428.4, "discounted_cash": 2818.0, "minimum": 60.06, "maximum": 17087.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2874.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3945.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4368.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5636.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ashkenazi Jewish Assoc Dsrdrs Gen Seq Anal 9 Gen", "code_information": [ { "code": "81412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2100.0, "discounted_cash": 2448.0, "minimum": 97.0, "maximum": 2100.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 515.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1713.99, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1713.99, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2100.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethosuximide", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.19, "discounted_cash": 16.0, "minimum": 11.43, "maximum": 174.19, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methemalbumin", "code_information": [ { "code": "83857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.82, "discounted_cash": 10.0, "minimum": 7.51, "maximum": 160.82, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2849.22, "discounted_cash": 2818.0, "minimum": 133.27, "maximum": 2849.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2329.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2677.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2849.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2846.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2818.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2789.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2087.14, "discounted_cash": 273.0, "minimum": 243.24, "maximum": 19609.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 383.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 260.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 424.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 273.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - G0480 - 30100020", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.89, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nicotine - G0480 - 30100416", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.67, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 159.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 159.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8156.49, "discounted_cash": 4966.0, "minimum": 80.08, "maximum": 8156.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5251.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5065.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6952.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4718.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7697.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8156.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5016.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4966.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4916.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.18, "discounted_cash": 11.0, "minimum": 8.38, "maximum": 253.18, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 844.29, "discounted_cash": 13.0, "minimum": 9.54, "maximum": 844.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 422.15, "10th_percentile": 422.15, "90th_percentile": 422.15, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 374.86, "10th_percentile": 9.54, "90th_percentile": 374.86, "count": "35" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 13.49, "10th_percentile": 13.49, "90th_percentile": 506.57, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nortiptyline - 80335 - 30100013", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 15.5, "maximum": 291.09, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - G0278 - 32300016", "code_information": [ { "code": "G0278", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17087.2, "minimum": 341.0, "maximum": 17087.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5251.43 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.0 } ] } ] }, { "description": "Hc Assay 17-(17-Ks)Ketosteroids", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.68, "discounted_cash": 12.0, "minimum": 8.96, "maximum": 151.68, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.38, "discounted_cash": 7.0, "minimum": 5.04, "maximum": 302.38, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nortiptyline - G0480 - 30100013", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Dilation", "code_information": [ { "code": "46604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4447.44, "discounted_cash": 1068.0, "minimum": 243.24, "maximum": 4447.44, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1238.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1089.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1495.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1014.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1655.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2136.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1068.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1057.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkal Phosphatase,Heat Stabl W/O Total", "code_information": [ { "code": "84078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.83, "discounted_cash": 8.0, "minimum": 5.78, "maximum": 146.83, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.18, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucagon", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 14.0, "minimum": 10.0, "maximum": 179.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Opiates - G0480 - 30100328", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2904.8, "discounted_cash": 830.0, "minimum": 243.24, "maximum": 2904.8, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 846.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1162.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1286.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1286.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1660.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 838.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 821.7, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1238.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 830.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.44, "discounted_cash": 14.0, "minimum": 10.34, "maximum": 165.44, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Inorganic Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.64, "discounted_cash": 4.0, "minimum": 3.31, "maximum": 216.64, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 96.19, "10th_percentile": 96.19, "90th_percentile": 96.19, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.91, "discounted_cash": 15.0, "minimum": 10.71, "maximum": 282.91, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.65, "discounted_cash": 4.0, "minimum": 3.32, "maximum": 42.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.6, "discounted_cash": 51.0, "minimum": 35.896, "maximum": 316.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.97, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.32, "discounted_cash": 12.0, "minimum": 9.06, "maximum": 126.32, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 317.9, "discounted_cash": 16.0, "minimum": 11.61, "maximum": 317.9, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 16.0, "minimum": 9.19, "maximum": 80.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.0, "discounted_cash": 4.0, "minimum": 3.41, "maximum": 202.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ketogenic Steroids", "code_information": [ { "code": "83582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.43, "discounted_cash": 15.0, "minimum": 10.82, "maximum": 154.43, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.83, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.83, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Procalcitonin", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.99, "discounted_cash": 27.0, "minimum": 16.05, "maximum": 306.99, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.2, "discounted_cash": 13.0, "minimum": 9.268, "maximum": 153.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.27, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.27, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.05, "discounted_cash": 20.0, "minimum": 14.0, "maximum": 157.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lap Enzyme", "code_information": [ { "code": "83670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 9.0, "minimum": 6.86, "maximum": 136.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone Receptor", "code_information": [ { "code": "84234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.32, "discounted_cash": 64.0, "minimum": 40.0, "maximum": 475.32, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 61.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 100.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 100.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.61, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.23, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 152.0, "minimum": 4.0, "maximum": 515.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Galactose Transferase", "code_information": [ { "code": "82775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.61, "discounted_cash": 21.0, "minimum": 14.749, "maximum": 215.61, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 447.78, "discounted_cash": 12.0, "minimum": 8.47, "maximum": 447.78, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.99, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.86, "discounted_cash": 19.0, "minimum": 13.3, "maximum": 300.86, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 13.52, "10th_percentile": 13.52, "90th_percentile": 102.9, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Screen Ea Antb", "code_information": [ { "code": "86036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.76, "discounted_cash": 12.0, "minimum": 8.43, "maximum": 61.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 5-Hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.97, "discounted_cash": 12.0, "minimum": 9.03, "maximum": 309.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lrh Hormone", "code_information": [ { "code": "83727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 853.9, "discounted_cash": 17.0, "minimum": 12.03, "maximum": 853.9, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate Kinase", "code_information": [ { "code": "84220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.76, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 177.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 11.0, "minimum": 7.81, "maximum": 183.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.81, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 292.81, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.17, "discounted_cash": 6.0, "minimum": 4.69, "maximum": 312.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 156.09, "10th_percentile": 156.09, "90th_percentile": 156.09, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 78.08, "10th_percentile": 57.51, "90th_percentile": 138.6, "count": "12" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 6.7, "10th_percentile": 6.7, "90th_percentile": 145.64, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 6.63, "10th_percentile": 6.63, "90th_percentile": 187.3, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serotonin", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.18, "discounted_cash": 30.0, "minimum": 16.05, "maximum": 163.18, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.67, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.47, "discounted_cash": 7.0, "minimum": 5.11, "maximum": 241.47, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.11 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.09, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.6, "discounted_cash": 13.0, "minimum": 9.61, "maximum": 516.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.06, "minimum": 304.218, "maximum": 1014.06, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1014.06 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.08, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 126.08, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nos Vitamin", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.57, "discounted_cash": 17.0, "minimum": 11.942, "maximum": 182.57, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.62, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.89, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroglobulin", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.19, "discounted_cash": 16.0, "minimum": 11.24, "maximum": 210.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 102.53, "10th_percentile": 102.53, "90th_percentile": 102.53, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.12, "discounted_cash": 249.0, "minimum": 54.44, "maximum": 519.12, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 349.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 499.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 166.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 166.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Nucleotidase 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.21, "discounted_cash": 11.0, "minimum": 7.8, "maximum": 132.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.8 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroid Stim Immunoglobulins (Tsi)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 458.95, "discounted_cash": 50.0, "minimum": 35.6, "maximum": 458.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 35.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 50.35, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1222.21, "discounted_cash": 145.0, "minimum": 54.44, "maximum": 1222.21, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 145.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - 80346 - 30100410", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 29.0, "minimum": 16.05, "maximum": 234.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 46.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 46.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.33, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tobramycin", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.89, "discounted_cash": 16.0, "minimum": 11.29, "maximum": 284.89, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.29, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.29, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.11, "discounted_cash": 249.0, "minimum": 54.44, "maximum": 534.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 349.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 237.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 386.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 499.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 252.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 249.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 247.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.13, "discounted_cash": 4.0, "minimum": 3.22, "maximum": 251.13, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenothiazine - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 166.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 166.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.11, "discounted_cash": 11.0, "minimum": 8.34, "maximum": 182.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12.0, "minimum": 3.615, "maximum": 12.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.27, "discounted_cash": 6.0, "minimum": 4.62, "maximum": 342.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenytoin, Total", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.77, "discounted_cash": 13.0, "minimum": 9.27, "maximum": 353.77, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 106.13, "10th_percentile": 106.13, "90th_percentile": 106.13, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.65, "discounted_cash": 12.0, "minimum": 8.93, "maximum": 283.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.67, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antibody Flow Cytometry Each", "code_information": [ { "code": "86053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.65, "discounted_cash": 37.0, "minimum": 13.3, "maximum": 188.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 37.35, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carbamazepine Total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.82, "discounted_cash": 14.0, "minimum": 10.19, "maximum": 381.82, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.19 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.63, "discounted_cash": 14.0, "minimum": 10.21, "maximum": 107.63, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 47.79, "10th_percentile": 47.79, "90th_percentile": 47.79, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 64.58, "10th_percentile": 64.58, "90th_percentile": 64.58, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 241.94, "discounted_cash": 5.0, "minimum": 3.62, "maximum": 241.94, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 120.97, "10th_percentile": 120.97, "90th_percentile": 120.97, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 104.8, "10th_percentile": 3.63, "90th_percentile": 107.42, "count": "17" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.63, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 252.12, "10th_percentile": 252.12, "90th_percentile": 252.12, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.62 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 5.13, "10th_percentile": 5.13, "90th_percentile": 5.13, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 152.0, "minimum": 4.0, "maximum": 515.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.57, "discounted_cash": 16.0, "minimum": 11.8, "maximum": 237.57, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.45, "discounted_cash": 27.0, "minimum": 16.05, "maximum": 325.45, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.25, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.01 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 301.05, "discounted_cash": 6.0, "minimum": 4.77, "maximum": 301.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 538.15, "discounted_cash": 118.0, "minimum": 2.09, "maximum": 538.15, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 112.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 900.38, "10th_percentile": 900.38, "90th_percentile": 900.38, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 184.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.5, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 119.33, "10th_percentile": 119.33, "90th_percentile": 119.33, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.56, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 139.85, "10th_percentile": 139.85, "90th_percentile": 139.85, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 238.94, "10th_percentile": 238.94, "90th_percentile": 238.94, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 118.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.5, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 121.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 514.94, "discounted_cash": 19.0, "minimum": 13.56, "maximum": 514.94, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.25, "discounted_cash": 5.0, "minimum": 3.54, "maximum": 188.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 389.86, "discounted_cash": 33.0, "minimum": 2.09, "maximum": 389.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 76.28, "10th_percentile": 76.28, "90th_percentile": 76.28, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 74.99, "10th_percentile": 74.99, "90th_percentile": 74.99, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 51.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 37.45, "10th_percentile": 37.45, "90th_percentile": 37.45, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.01, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.35, "discounted_cash": 10.0, "minimum": 7.51, "maximum": 145.35, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.86, "discounted_cash": 18.0, "minimum": 12.87, "maximum": 311.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.76, "10th_percentile": 146.76, "90th_percentile": 146.76, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 133.58, "10th_percentile": 12.87, "90th_percentile": 133.58, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 18.21, "10th_percentile": 18.21, "90th_percentile": 180.52, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Total", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.25, "discounted_cash": 13.0, "minimum": 9.47, "maximum": 297.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood Thaw Per Unit", "code_information": [ { "code": "86931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047.1, "discounted_cash": 152.0, "minimum": 33.92, "maximum": 1047.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 235.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 460.46, "discounted_cash": 6.0, "minimum": 4.55, "maximum": 460.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 224.62, "10th_percentile": 6.51, "90th_percentile": 230.23, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 204.44, "10th_percentile": 59.57, "90th_percentile": 204.44, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 178.0, "10th_percentile": 178.0, "90th_percentile": 178.0, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.59, "discounted_cash": 14.0, "minimum": 10.13, "maximum": 158.59, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.0, "discounted_cash": 11.0, "minimum": 8.12, "maximum": 171.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 102.6, "10th_percentile": 102.6, "90th_percentile": 102.6, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 502.0, "discounted_cash": 46.0, "minimum": 5.48, "maximum": 514.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 251.0, "10th_percentile": 251.0, "90th_percentile": 251.0, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 228.46, "10th_percentile": 228.46, "90th_percentile": 228.46, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 72.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 72.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.0, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 46.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 114.1, "10th_percentile": 114.1, "90th_percentile": 114.1, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosteroids", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.94, "discounted_cash": 17.0, "minimum": 12.53, "maximum": 195.94, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.53 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Quinidine", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.46, "discounted_cash": 14.0, "minimum": 10.22, "maximum": 375.46, "payers_information": [ { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.22 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.45, "discounted_cash": 21.0, "minimum": 14.86, "maximum": 223.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 111.73, "10th_percentile": 111.73, "90th_percentile": 111.73, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.41, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 21.02, "10th_percentile": 21.02, "90th_percentile": 134.07, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Pretreatment,Serum Inhib", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.67, "discounted_cash": 152.0, "minimum": 12.0, "maximum": 169.67, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 169.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 169.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 169.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 152.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 150.53, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Desipramine - 80335 - 30100403", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 15.5, "maximum": 291.09, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Salicylate - 80329 - 30100044", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Synovial Fluid Mucin", "code_information": [ { "code": "83872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.49, "discounted_cash": 5.0, "minimum": 4.1, "maximum": 70.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1596.69, "minimum": 243.24, "maximum": 1596.69, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 } ] } ] }, { "description": "Hc Assay Of Desipramine - G0480 - 30100403", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 145.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Silica", "code_information": [ { "code": "84285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.25, "discounted_cash": 25.0, "minimum": 14.0, "maximum": 252.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.99, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Total Hydroxyproline", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.34, "discounted_cash": 24.0, "minimum": 16.05, "maximum": 298.34, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.95, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aspa Gene", "code_information": [ { "code": "81200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2624.89, "discounted_cash": 47.0, "minimum": 33.075, "maximum": 2624.89, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 33.08, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.08, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 73.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 73.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 46.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Dibucaine Number", "code_information": [ { "code": "82638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.72, "discounted_cash": 12.0, "minimum": 8.57, "maximum": 127.72, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Theophylline", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.16, "discounted_cash": 14.0, "minimum": 9.89, "maximum": 320.16, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Free Hydroxyproline", "code_information": [ { "code": "83500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.53, "discounted_cash": 22.0, "minimum": 15.85, "maximum": 330.53, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.86, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.86, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.05, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 16.0, "minimum": 11.809, "maximum": 117.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% 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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.71, "discounted_cash": 13.0, "minimum": 9.29, "maximum": 92.71, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thiocyanate", "code_information": [ { "code": "84430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.0, "discounted_cash": 11.0, "minimum": 8.14, "maximum": 156.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Toxin Or Antitoxin", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.04, "discounted_cash": 19.0, "minimum": 9.19, "maximum": 199.04, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.14, "discounted_cash": 12.0, "minimum": 8.62, "maximum": 278.14, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.27, "discounted_cash": 24.0, "minimum": 16.05, "maximum": 313.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.39, "discounted_cash": 25.0, "minimum": 16.05, "maximum": 670.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 335.2, "10th_percentile": 335.2, "90th_percentile": 335.2, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 290.39, "10th_percentile": 290.39, "90th_percentile": 297.65, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 654.04, "10th_percentile": 79.08, "90th_percentile": 670.39, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 402.23, "10th_percentile": 402.23, "90th_percentile": 402.23, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assayof Estrogen Receptor", "code_information": [ { "code": "84233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2190.75, "discounted_cash": 87.0, "minimum": 40.0, "maximum": 2190.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 61.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.52, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 136.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 136.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.06, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Collagen Cross Links", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.33, "discounted_cash": 18.0, "minimum": 13.07, "maximum": 208.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.49, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Thyroxine", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.63, "discounted_cash": 6.0, "minimum": 4.8, "maximum": 244.63, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 4.81, "10th_percentile": 4.81, "90th_percentile": 4.81, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 238.66, "10th_percentile": 238.66, "90th_percentile": 244.63, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assessment Of Aphasia", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 404.0, "discounted_cash": 91.0, "minimum": 87.248, "maximum": 404.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 404.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 91.84 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 142.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 142.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.68 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 91.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 90.92, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 17-Hydroxypregneno", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.23, "discounted_cash": 22.0, "minimum": 15.96, "maximum": 255.23, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Free Thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.4, "discounted_cash": 9.0, "minimum": 6.31, "maximum": 307.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 153.7, "10th_percentile": 153.7, "90th_percentile": 153.7, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 136.49, "10th_percentile": 6.31, "90th_percentile": 136.49, "count": "61" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 16.08, "10th_percentile": 9.02, "90th_percentile": 463.1, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 184.44, "10th_percentile": 8.93, "90th_percentile": 184.44, "count": "11" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transcortin", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.36, "discounted_cash": 18.0, "minimum": 12.6, "maximum": 190.36, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.7, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Autologous Blood, Op Salvage", "code_information": [ { "code": "86891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5531.26, "discounted_cash": 719.0, "minimum": 33.92, "maximum": 5531.26, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 733.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1006.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 683.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1114.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 1114.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1438.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 726.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 719.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 711.89, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aluminum", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 278.1, "discounted_cash": 25.0, "minimum": 14.0, "maximum": 278.1, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.83 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Galactose", "code_information": [ { "code": "82760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.04, "discounted_cash": 11.0, "minimum": 7.84, "maximum": 76.04, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Troponin Qual", "code_information": [ { "code": "84512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.0, "discounted_cash": 10.0, "minimum": 7.063, "maximum": 159.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacteria Culture Screen", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 594.11, "discounted_cash": 6.0, "minimum": 4.64, "maximum": 594.11, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 220.03, "10th_percentile": 220.03, "90th_percentile": 237.64, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 73.16, "10th_percentile": 73.16, "90th_percentile": 73.16, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.73, "discounted_cash": 15.0, "minimum": 10.55, "maximum": 217.73, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.55 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Iga, Igd, Igg, Igm, Each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.86, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 257.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 9.3, "10th_percentile": 9.3, "90th_percentile": 9.3, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 114.49, "10th_percentile": 114.49, "90th_percentile": 114.49, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.53, "discounted_cash": 4.0, "minimum": 3.16, "maximum": 277.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 4.52, "10th_percentile": 4.52, "90th_percentile": 138.77, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 3.16, "10th_percentile": 3.16, "90th_percentile": 123.22, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.16, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.16 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bactericidal Level Serum", "code_information": [ { "code": "87197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.51, "discounted_cash": 15.0, "minimum": 9.19, "maximum": 205.51, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.51, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.51, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - 80335 - 30100408", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.09, "minimum": 15.5, "maximum": 291.09, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Glucosidase", "code_information": [ { "code": "82963", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 318.31, "discounted_cash": 21.0, "minimum": 15.03, "maximum": 318.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.7, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood, Other Source", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.15, "discounted_cash": 5.0, "minimum": 3.55, "maximum": 270.15, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bacterium, Antibody", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.0, "discounted_cash": 12.0, "minimum": 9.01, "maximum": 149.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.24, "discounted_cash": 14.0, "minimum": 10.19, "maximum": 449.24, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 58.11, "10th_percentile": 58.11, "90th_percentile": 58.11, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.19 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Haloperidol", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.0, "discounted_cash": 15.0, "minimum": 11.04, "maximum": 162.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Alkaloids - 80323 - 30100213", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Bcr/Abl1 Gene Major Bp", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 819.8, "discounted_cash": 163.0, "minimum": 40.0, "maximum": 819.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.77, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.77, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 155.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 600.69, "10th_percentile": 600.69, "90th_percentile": 600.69, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 254.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 254.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.55, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 162.32, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - 80324 - 30100323", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Haptoglobin, Quant", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.31, "discounted_cash": 12.0, "minimum": 8.8, "maximum": 168.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.76, "discounted_cash": 5.0, "minimum": 4.02, "maximum": 147.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bile Acids, Total", "code_information": [ { "code": "82239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.0, "discounted_cash": 17.0, "minimum": 11.98, "maximum": 187.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.53, "discounted_cash": 6.0, "minimum": 4.53, "maximum": 387.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 189.04, "10th_percentile": 189.04, "90th_percentile": 189.04, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.53 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemoglobin Heat", "code_information": [ { "code": "83065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.33, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 159.33, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Hemoglobin", "code_information": [ { "code": "83069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.75, "discounted_cash": 3.0, "minimum": 2.76, "maximum": 107.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.77, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Of Prostate,Needle/Punch", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2066.0, "discounted_cash": 1789.0, "minimum": 619.8, "maximum": 2066.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1945.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1825.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2066.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1700.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2066.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2066.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2066.0, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1807.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1789.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1771.67, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.23, "discounted_cash": 18.0, "minimum": 13.27, "maximum": 173.23, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Histamine", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.71, "discounted_cash": 29.0, "minimum": 15.5, "maximum": 296.71, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.23, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sulfate", "code_information": [ { "code": "84392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.45, "discounted_cash": 5.0, "minimum": 3.51, "maximum": 71.45, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.84 } ] } ] }, { "description": "Hc Biopsy Of Soft Tissues", "code_information": [ { "code": "27040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3767.92, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 3767.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of B Hexosaminidase", "code_information": [ { "code": "83080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.73, "discounted_cash": 16.0, "minimum": 11.8, "maximum": 274.73, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Imipramine - 80335 - 30100017", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 15.5, "maximum": 291.09, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Urobilinogen Urine Qual", "code_information": [ { "code": "84578", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.57, "discounted_cash": 4.0, "minimum": 3.12, "maximum": 33.57, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 33.57 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.57 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.43, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Of Thyroid,Percut", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2964.05, "discounted_cash": 632.0, "minimum": 600.419, "maximum": 2964.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1171.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin,Total", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.93, "discounted_cash": 11.0, "minimum": 8.0, "maximum": 242.93, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Free", "code_information": [ { "code": "80165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.44, "discounted_cash": 13.0, "minimum": 9.47, "maximum": 239.44, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Back,Deep", "code_information": [ { "code": "21925", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4242.84, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 4242.84, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Fatty Acids", "code_information": [ { "code": "82725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "discounted_cash": 18.0, "minimum": 13.13, "maximum": 145.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "minimum": 6.23, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Vip", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 369.5, "discounted_cash": 35.0, "minimum": 16.05, "maximum": 369.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.56, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.63, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.98, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6830.25, "discounted_cash": 1474.0, "minimum": 243.24, "maximum": 6830.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2860.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Hdl Cholest", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.24, "discounted_cash": 8.0, "minimum": 5.73, "maximum": 127.24, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Myoglobin", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.87, "discounted_cash": 12.0, "minimum": 9.04, "maximum": 287.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 12.92, "10th_percentile": 12.92, "90th_percentile": 12.92, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.55, "discounted_cash": 14.0, "minimum": 9.92, "maximum": 158.55, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.93, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 95.13, "10th_percentile": 95.13, "90th_percentile": 95.13, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Viii, Vw Fc Antigen", "code_information": [ { "code": "85246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.03, "discounted_cash": 22.0, "minimum": 4.74, "maximum": 179.03, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.71, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.48, "discounted_cash": 10.0, "minimum": 7.35, "maximum": 112.48, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Neonatal Thyroxine", "code_information": [ { "code": "84437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.98, "discounted_cash": 6.0, "minimum": 4.529, "maximum": 32.98, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.98 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Zinc", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 143.5, "discounted_cash": 11.0, "minimum": 7.97, "maximum": 143.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 86.1, "10th_percentile": 86.1, "90th_percentile": 86.1, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Viii, Vw Fc, Ristocetin Cofactr", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 331.41, "discounted_cash": 22.0, "minimum": 4.74, "maximum": 331.41, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.94, "discounted_cash": 20.0, "minimum": 14.56, "maximum": 218.94, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.93, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nicotine - 80323 - 30100416", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.67, "minimum": 15.5, "maximum": 572.15, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Other Fluid Chlorides", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.19, "discounted_cash": 5.0, "minimum": 3.5, "maximum": 130.19, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor Ii Test", "code_information": [ { "code": "85210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.17, "discounted_cash": 12.0, "minimum": 4.74, "maximum": 477.17, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254.65, "discounted_cash": 6.0, "minimum": 4.22, "maximum": 254.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.97, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.09, "discounted_cash": 14.0, "minimum": 10.11, "maximum": 142.09, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid, Total", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.0, "discounted_cash": 7.0, "minimum": 5.34, "maximum": 113.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor V Test", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.38, "discounted_cash": 17.0, "minimum": 4.74, "maximum": 186.38, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Total", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 416.93, "discounted_cash": 5.0, "minimum": 3.61, "maximum": 416.93, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Porphyrins Urine Quan&Fxj", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.95, "discounted_cash": 14.0, "minimum": 10.29, "maximum": 217.95, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphohexose Enzymes", "code_information": [ { "code": "84087", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.0, "discounted_cash": 10.0, "minimum": 7.51, "maximum": 491.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Factor Viii Test, One Stage", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.76, "discounted_cash": 17.0, "minimum": 4.74, "maximum": 348.76, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.53 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 807.4, "discounted_cash": 27.0, "minimum": 15.5, "maximum": 807.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.52, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pregnanetriol", "code_information": [ { "code": "84138", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.4, "discounted_cash": 21.0, "minimum": 14.73, "maximum": 356.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Sngl Organic Acid, Quantitative", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 947.91, "discounted_cash": 21.0, "minimum": 14.84, "maximum": 947.91, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Clot Retraction", "code_information": [ { "code": "85170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 16.0, "minimum": 4.74, "maximum": 53.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cocaine - G0480 - 30100327", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pregnenolone", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 465.92, "discounted_cash": 20.0, "minimum": 14.46, "maximum": 465.92, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.77, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Test For Blood Fecal", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.19, "discounted_cash": 15.0, "minimum": 11.14, "maximum": 210.19, "payers_information": [ { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 63.06, "10th_percentile": 63.06, "90th_percentile": 63.06, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Culture For Bacteria", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.08, "discounted_cash": 10.0, "minimum": 7.22, "maximum": 324.08, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 80.93, "10th_percentile": 72.72, "90th_percentile": 151.02, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 260.28, "10th_percentile": 260.28, "90th_percentile": 260.28, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosterone", "code_information": [ { "code": "82528", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.17, "discounted_cash": 22.0, "minimum": 15.76, "maximum": 345.17, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 818.48, "discounted_cash": 20.0, "minimum": 14.6, "maximum": 818.48, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.99, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Urine Urea-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.12, "discounted_cash": 5.0, "minimum": 3.89, "maximum": 135.12, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Draw <3 Yrs, Skilled Phys, Scalp", "code_information": [ { "code": "36405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "minimum": 2.98, "maximum": 136.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2.98 } ] } ] }, { "description": "Hc Assay Of Cyanide", "code_information": [ { "code": "82600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.97, "discounted_cash": 19.0, "minimum": 13.58, "maximum": 174.97, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Proinsulin", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.52, "discounted_cash": 26.0, "minimum": 16.05, "maximum": 244.52, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.69, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.42, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.8, "discounted_cash": 38.0, "minimum": 26.95, "maximum": 401.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.28, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 241.08, "10th_percentile": 241.08, "90th_percentile": 241.08, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Fungus Culture", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.05, "discounted_cash": 20.0, "minimum": 9.19, "maximum": 414.05, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.53, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 20.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Doxepin - 80335 - 30100409", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.8, "minimum": 15.5, "maximum": 291.09, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Quinine", "code_information": [ { "code": "84228", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 11.0, "minimum": 8.14, "maximum": 186.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.51, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Non-Endocrine Receptor", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 349.29, "discounted_cash": 36.0, "minimum": 25.59, "maximum": 349.29, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.06, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Gases O2 Sat Only", "code_information": [ { "code": "82810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.3, "discounted_cash": 9.0, "minimum": 6.83, "maximum": 600.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Endocrine Hormone", "code_information": [ { "code": "84235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.79, "discounted_cash": 71.0, "minimum": 40.0, "maximum": 398.79, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.86, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 72.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 110.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 110.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.91, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 70.52, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Rbc Galactokinase", "code_information": [ { "code": "82759", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.62, "discounted_cash": 21.0, "minimum": 15.03, "maximum": 341.62, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.7, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Urine Catecholamines", "code_information": [ { "code": "82382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 876.21, "discounted_cash": 27.0, "minimum": 16.05, "maximum": 876.21, "payers_information": [ { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 19.11, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.11, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.4, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Gases: Ph, Po2 & Pco2 W O2 Satu", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.69, "discounted_cash": 78.0, "minimum": 40.0, "maximum": 780.69, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 346.63, "10th_percentile": 346.63, "90th_percentile": 346.63, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 55.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.13 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.98, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.63, "discounted_cash": 18.0, "minimum": 13.15, "maximum": 230.63, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 165.96, "10th_percentile": 165.96, "90th_percentile": 165.96, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.61, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Renin", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 388.52, "discounted_cash": 21.0, "minimum": 15.39, "maximum": 388.52, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Auditory Function 60 Min", "code_information": [ { "code": "92620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.75, "discounted_cash": 114.0, "minimum": 74.0, "maximum": 589.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 294.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 229.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.68, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Methemoglobin, Quant", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.19, "discounted_cash": 8.0, "minimum": 5.74, "maximum": 138.19, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.6, "discounted_cash": 32.0, "minimum": 16.05, "maximum": 352.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.15, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 31.98, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Salicylate - G0480 - 30100044", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.15, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc B-12 Binding Capacity", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 14.0, "minimum": 10.02, "maximum": 128.0, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Smear Interpretation", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.71, "minimum": 15.45, "maximum": 68.71, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.45 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.0, "discounted_cash": 14.0, "minimum": 10.43, "maximum": 214.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 10.43, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.43, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Potassium", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.31, "discounted_cash": 4.0, "minimum": 3.33, "maximum": 173.31, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 50.72, "10th_percentile": 50.72, "90th_percentile": 50.72, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 4.71, "10th_percentile": 4.71, "90th_percentile": 4.71, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bartonella Dna Amp Probe", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.25, "discounted_cash": 35.0, "minimum": 24.56, "maximum": 603.25, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.56, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.35, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.56 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Sulfhemoglobin Assay", "code_information": [ { "code": "83060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.69, "discounted_cash": 8.0, "minimum": 6.16, "maximum": 104.69, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - 80354 - 30100020", "code_information": [ { "code": "80354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.89, "minimum": 15.5, "maximum": 439.89, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 } ] } ] }, { "description": "Hc Assay Of Serum Sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.22, "discounted_cash": 4.0, "minimum": 3.36, "maximum": 184.22, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.37, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.37, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 4.76, "10th_percentile": 4.76, "90th_percentile": 4.76, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Basic Metabolic Panel Calcium Total", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 899.99, "discounted_cash": 8.0, "minimum": 5.92, "maximum": 899.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 450.0, "10th_percentile": 439.02, "90th_percentile": 450.0, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 136.79, "10th_percentile": 5.92, "90th_percentile": 447.06, "count": "27" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 12634.07, "10th_percentile": 878.04, "90th_percentile": 29519.8, "count": "27" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 115.5, "10th_percentile": 40.07, "90th_percentile": 684.56, "count": "1 through 10" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Type Antigen Donor Reagent Serum, Ea Ag", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1514.3, "discounted_cash": 319.0, "minimum": 5.48, "maximum": 1514.3, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 447.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 303.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 495.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 639.82, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 319.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 316.71, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fluoride", "code_information": [ { "code": "82735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.4, "discounted_cash": 18.0, "minimum": 12.97, "maximum": 257.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sex Hormone Binding Globulin", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.56, "discounted_cash": 21.0, "minimum": 15.21, "maximum": 519.56, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bcr/Abl1 Gene Minor Bp", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 724.2, "discounted_cash": 144.0, "minimum": 40.0, "maximum": 724.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 101.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.39, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.57, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 143.39, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood/Lymph System Procedure", "code_information": [ { "code": "38999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1914.5, "discounted_cash": 393.0, "minimum": 374.0625, "maximum": 1914.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1914.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 374.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 610.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 610.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 787.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 511.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 393.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 389.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Flurazepam - G0480 - 30100014", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.74, "discounted_cash": 114.0, "minimum": 13.857, "maximum": 572.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 146.63, "10th_percentile": 146.63, "90th_percentile": 146.63, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.1, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 116.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 169.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 113.29, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sialic Acid", "code_information": [ { "code": "84275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.65, "discounted_cash": 13.0, "minimum": 9.4, "maximum": 149.65, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.41, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Beta-2 Protein", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.33, "discounted_cash": 16.0, "minimum": 11.32, "maximum": 177.33, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.61, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bone Biopsy,Trocar/Needle Deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7071.4, "discounted_cash": 1474.0, "minimum": 325.58, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 325.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1477.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Folic Acid, Rbc", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.62, "discounted_cash": 17.0, "minimum": 12.35, "maximum": 238.62, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatomedin", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.57, "discounted_cash": 21.0, "minimum": 14.88, "maximum": 273.57, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biofeedback Train Any Meth", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.63, "discounted_cash": 15.0, "minimum": 15.1335, "maximum": 168.63, "payers_information": [ { "payer_name": "Americas Choice Provider Network", "plan_name": "Americas Choice Provider Network Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.36 }, { "payer_name": "Corvel", "plan_name": "Corvel Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.68 }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Compone", "plan_name": "Compone Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Multiplan", "plan_name": "Multiplan Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.36 }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Novanet", "plan_name": "Novanet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89 }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.86 }, { "payer_name": "Occunet", "plan_name": "Occunet Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.36 }, { "payer_name": "Prime Health Services", "plan_name": "Prime Health Services Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.36 }, { "payer_name": "Provider Network of America", "plan_name": "Provider Network of America Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.57 }, { "payer_name": "Provider Select", "plan_name": "Provider Select Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.83 }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Three Rivers", "plan_name": "Three Rivers Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.57 }, { "payer_name": "Zelis(fka Stratose)", "plan_name": "Zelis(fka Stratose) Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89 } ] } ] }, { "description": "Hc Bone Marrow Bx, Needle/Trocar", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7248.19, "discounted_cash": 1474.0, "minimum": 286.51, "maximum": 19254.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1515.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1503.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2063.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1400.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 2284.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2948.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1488.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 286.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 1474.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1459.34, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of For Hva", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 22.0, "minimum": 15.68, "maximum": 175.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.69, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.77, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatostatin", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.0, "discounted_cash": 18.0, "minimum": 12.79, "maximum": 294.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Shoulder Deep", "code_information": [ { "code": "23066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4242.84, "discounted_cash": 2592.0, "minimum": 243.24, "maximum": 4242.84, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2225.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2644.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3629.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2462.88, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 4018.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4242.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2618.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 243.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 1704.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 2592.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2566.58, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bordetella Antibody", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.69, "discounted_cash": 13.0, "minimum": 9.23, "maximum": 133.69, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.23, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.23 }, { "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": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fructose Semen", "code_information": [ { "code": "82757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.62, "discounted_cash": 17.0, "minimum": 12.13, "maximum": 341.62, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sweat Sodium", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.49, "discounted_cash": 4.0, "minimum": 3.4, "maximum": 82.49, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 3.4, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.4, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy, Nail Unit (Sep Proc)", "code_information": [ { "code": "11755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 995.19, "discounted_cash": 632.0, "minimum": 298.557, "maximum": 995.19, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 600.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 979.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 995.19, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 638.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 909.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 632.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.7, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brca1 & Brca2 Full Seq Analys/Full Dup/Del Analys", "code_information": [ { "code": "81162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 1824.0, "minimum": 40.0, "maximum": 10391.7, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 515.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 962.28, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of G6Pd Enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.45, "discounted_cash": 9.0, "minimum": 6.23, "maximum": 108.45, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 663.31, "discounted_cash": 25.0, "minimum": 16.05, "maximum": 663.31, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 44.4, "median_amount": 287.33, "10th_percentile": 287.33, "90th_percentile": 294.51, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 198.99, "10th_percentile": 25.47, "90th_percentile": 663.31, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.29, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "99.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bld Clot Factor Xiii, Screen Solubility", "code_information": [ { "code": "85291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.02, "discounted_cash": 9.0, "minimum": 4.74, "maximum": 176.02, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Brca2 Gene Known Fam Variant", "code_information": [ { "code": "81217", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.06, "discounted_cash": 375.0, "minimum": 40.0, "maximum": 558.06, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS AL Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Select Plus", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare HMO & PPO - True Choice", "methodology": "fee schedule", "standard_charge_dollar": 262.68, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Health Spring Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 262.68, "additional_payer_notes": "Laboratory - 70.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 525.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "EVERNORTH BEHAVIORAL HEALTH", "plan_name": "EVERNORTH BEHAVIORAL HEALTH MEDICARE ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Service Center", "plan_name": "Health Service Center Medicare - OP Only", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Tricare", "methodology": "fee schedule", "standard_charge_dollar": 356.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "NaphCare Prison", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Centers - Prison", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Occunet", "plan_name": "Occunet Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.54, "additional_payer_notes": "Laboratory - 115.00% of Medicare Rates" }, { "payer_name": "Simpra Advantage", "plan_name": "Simpra Advantage Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.0, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC All Payer", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.0 }, { "payer_name": "United HealthCare", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United HealthCare", "plan_name": "UHC Veterans Choice", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Viva Health", "plan_name": "Viva Health Medicare (07-09-2025 - 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 371.5, "additional_payer_notes": "99.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.23, "discounted_cash": 16.0, "minimum": 11.52, "maximum": 250.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount":